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ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: March 23, 2016
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Rooms
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
Public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of March 23, 2016 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of February 24, 2016
7:15 – 7:30 V. Educational Sessions
A. CHA Review Ashley Mercer
7:30 – 8:45 VI. Action Items (Non Consent)
A. Integrated Behavioral Health Proposal Hannah Welch & Kathleen
Goodhand
B. Strategic Planning Process Pt. I Colleen Bridger
8:45 – 8:50 VII. Reports and Discussion with Possible Action
A. Health Director Report Colleen Bridger
B. Media Items
8:50 – 8:55 VIII. Board Comments
8:55 IX. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov
advising her of your attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound
equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to
request an interpreter or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete
y/o equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para
Inmigrantes y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones.
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ORANGE COUNTY BOARD OF HEALTH
February 24, 2016
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON February 24, 2016, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Chair; Nick Galvez, Vice Chair;
Commissioner Mia Burroughs, Paul Chelminski, Susan Elmore, Jessica Frega, Sam Lasris,
Reena Mehta and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Barbara Chavious and Dan Dewitya.
STAFF PRESENT: Dr. Colleen Bridger, Health Director; Alan Clapp, Environmental Health
Director; Rebecca Crawford, Finance & Administrative Services Division Director; Dr. Michael
Day, Dentist; Michael Futch, Public Health Nurse II; Donna King, Health Promotion & Education
Services Director; Pam McCall, Public Health Nursing Director; Meredith McMonigle, Senior
Public Health Educator; Kimberlee Quatrone, Administrative Officer; Stacy Shelp,
Communications Manager; and La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: None.
I. Welcome New Employees
Dr. Bridger introduced new staff member: Matthew Futch, Public Health Nurse II.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the February 24, 2015 Agenda
Motion was made by Susan Elmore to approve the agenda, seconded by Paul Chelminski
and carried without dissent.
IV. Action Items (Consent)
A. Minutes Approval of January 27, 2015 Meeting
Motion to approve Consent Agenda with corrections to Liska Lackey’s title in the
January 27, 2016 minutes was made by Susan Elmore, seconded by Jessica Frega and
carried without dissent.
V. Educational Sessions
A. Family Success Alliance Update
Meredith McMonigle, Senior Public Health Educator, began by stating that the Family Success
Alliance (FSA) was in its 2nd year. The FSA has two zones in which it jointly works with schools,
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February 24, 2016
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community partners, faith-based groups and advocates to build a cradle to college and career
pipeline of supports for children and families living there. Ms. McMonigle shared that the FSA
had piloted a k-readiness program that served 67 incoming kindergarteners. There were four
navigators hired to engage directly with the families located in the zones. The navigators also
assist in bridging some of the gaps in communication and trust. They are natural leaders in their
communities and either live or have children that live in these zones.
The four goals associated with the FSA are:
• Children are healthy and prepared for school.
• Children and youth are healthy and succeed in school.
• Youth graduate from high school and college.
• Families and neighborhoods support the healthy development of children.
Each zone has different priorities based on discussion with parents, service providers and other
community members at zone meetings held in April 2015. The participants voted and chose
priorities to guide the FSA to initial areas for action. The zone 4 priorities are transportation,
kindergarten readiness, childcare and family support. The zone 6 priorities are housing, family
support, kindergarten readiness and childcare.
Nine service provider partners are offering additional wrap around services including ESL and
GED classes, school-based mental health services and early education programs. Dr. Bridger
added that the UNC Frank Porter Graham Institute will be creating a children’s data center. She
also mentioned that many community organizations/potential partners have reached out and
offered their assistance including a recent donation from the Doval and Theresa Watson
Foundation.
The BOH members had questions that were addressed by Ms. McMonigle and Dr.
Bridger.
B. Outside Agency Review Process
La Toya Strange, Administrative Assistant, summarized the Outside Agency Review process
and the assignments required of Board of Health members for evaluating applications. The
Health Department received seven applications to review. Board members are to review the 2-
3 applications assigned to them, record scores on the scoring cards and send the completed
scoring cards back to Ms. Strange by March 18th.
The BOH members did not have any questions.
C. Annual Report
Stacy Shelp, Communications Manager, provided the Board with highlights of the 2015 Annual
Report which included:
• Environmental Health’s Food and Lodging completed 100% of their required inspections
• Naloxone Access Program resulted in 4 overdose reversals.
• Healthy Carolinians conducted their four year Community Health Assessment with over
1700 responses.
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• 100% of clients in the Diabetes Self-Management classes rated the program as
“Excellent” or “Very Good” on their evaluations.
The 2015 Annual Report can be found online at
http://www.orangecountync.gov/Annual_Report_2015_FINAL.pdf
The BOH members had questions that were addressed by Ms. Shelp and Dr. Bridger.
D. Debt Set-Off Program Update
Rebecca Crawford, Finance & Administrative Services Division Director, notified the Board that
the Personal Health, Dental Health, and Environmental Health continue to participate in the NC
Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a
balance between $50 and $4,000 through the customer’s tax refund. This has proven to be a
successful way to recoup funds from overdue accounts, although FY 14-15 total amounts are
much higher than FY 15-16 amounts as the prior year included multiple years of delinquent
accounts whereas FY 15-16 is from July 1, 2015 through January 31, 2016. The Personal
Health division has also found that letters sent to delinquent accounts that warn of the potential
to be sent to debt set-off have netted $1,796.40 for the period of July 1, 2015 through February
11, 2016.
The BOH members did not have any questions.
E. Population Health Dashboards
Dr. Bridger reminded the Board that the dashboards can be found on the Orange County Health
Department’s website. Included were the Board of Health priorities, Substance Abuse & Mental
Health, Child and Family Obesity and Access to Care dashboards. The dashboards show what
the trend is as well as compares data between Orange County and the US overall. The
dashboards are updated annually.
The BOH members had questions that were addressed by Dr. Bridger.
VI. Action Items (Non-Consent)
A. 2016-2017 Budget and Fee Schedule & Requested Changes
Dr. Bridger presented the Board with a summary of the proposed FY 2016-2017 budget for the
Health Department which shows an increase in expenditures of $590,561; $379,468 of which
are expenditure increases related to the FY 15-16 wage increase and increases to the medical
insurance and retirement insurance rates, which are outside of the control of the department.
The remaining $241,093 of the total increase is due to new and expanded services including
$105,000 for the Family Success Alliance and $75,000 for Primary Care services for uninsured
men. Staff projects a $328,611 increase in revenues for FY 16-17, which will offset all of the
$241,093 increase and leave a balance of revenue of $87,518. This additional revenue
decreases the general fund burden of the wage increase and makes the total FY 16-17 Health
Department requested increase for County General Funds $291,951.
The proposed total budget is $10,062,417 which includes $103,536 in grant funding for the
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Susan G. Komen and Health Disparities projects and $705,000 (level funding) for school nurses
in both Orange County school systems.
In relation to new staff requests, the Health Department requests a total of 1.4 FTE; a new 1.0
FTE Public Health Educator to serve as a community liaison and a 0.4 FTE for the Healthy
Homes Asthma program, which will be added to the existing 0.6 FTE Public Health
Preparedness position to total 1.0 FTE. The Health Department requires no additional funding to
support these positions as they will be absorbed within the existing budget.
In relation to state funding, the state has provided us with the FY 16-17 Consolidated
Agreement Addenda. Even though we will no longer receive funding for Ebola, the Maternal and
Child Health Planning grant, or the Oral Health grant we received in FY 15-16, we will receive
additional funding for Prescription Drug Overdoses. Changes in funding for all other, ongoing
Health Department programs equals out to the prior fiscal year.
With regards to fee changes, the FY 2016-2017 requested budget includes fee changes for the
Personal Health and Environmental Health divisions. Staff recommends multiple fee changes
for Personal Health to cover the increased cost of vaccines, add a minimum lab fee for self-pay
clients, and adjust the fee for 340B drugs according to changes in the state and federal policies
around 340B drugs. Also, during the FY 15-16 budget cycle, the Board of Health voted to enact
Phase I of a three year phased Environmental Health fee increase in order to reach full cost
recovery for Environmental Health. Staff recommends enacting Phase II of the three year fee
increase by raising fees an additional 11% over last year’s increases.
Motion to approve to approve the total budget requested in the amount of $10,032,417 for
2016-2017 as presented which includes $103,536 in grant funding for the Susan G.
Komen and Health Disparities projects, and forward to the County Manager or Board of
County Commissioners for action without edits was made by Paul Chelminski, seconded
by Susan Elmore and carried without dissent.
Dr. Bridger facilitated a discussion about the proposed fee changes which touched briefly on the
fee changes in Personal Health and to continue with Phase II of the planned fee increases in
the Environmental Health division. The proposed changes are:
Personal Health proposes the implementation of a minimum charge for laboratory procedures to
recoup a small portion of labs performed for primary care patients. The average primary care
patient requires multiple labs per visit, equating to between $24 and $185, or an average of
$102 in charges. Patients pay for these labs according to where they fall on the sliding fee
scale; however 0% pay patients do not pay anything for labs. The proposed minimum fee of $20
would be equal to other minimum fees within the Health Department for MNT and DSME
services, which have both proven to not be cost prohibitive for clients.
Personal Health also requests fee increases for multiple vaccines that are rising in cost and
adjustments to our fees for 340B drugs (Family Planning drugs not including birth control pills)
to make them match the county’s cost to purchase them, as required by the state and federal
government. This will have very little impact on both the department and patients as only 10% of
self-pay patients pay more than $0 for Family Planning drugs or procedures and of that 10% we
had no patients in prior years that have had to pay 100% of the cost.
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Board of Health voted to enact Phase I of a three year phased Environmental Health fee
increase in order to reach full cost recovery for on-site and well services during the FY 15-16
budget process.
Motion to approve all fee changes for FY 2016-2017 as presented and forward to the
Board of County Commissioners for action without edits was made by Susan Elmore,
seconded by Reena Mehta and carried without dissent.
The BOH members had questions that were addressed by Dr. Bridger.
VII. Reports and Discussion with Possible Action
A. Health Director Report
Dr. Bridger’s report acknowledged that NC has one confirmed case of the Zika virus which was
contracted when the individual traveled to one of the affected countries. Dr. Bridger stated that
the state will continue to increase monitoring/surveillance. She also added that the Zika virus
can be spread by a man through unprotected sex.
In other news, Dr. Michael Day announced that Dr. Ashley Mann has offered to donate a
panoramic dental x-ray machine to the Orange County Health Department. This donation is
valued at approximately $30,000.
The BOH members had questions that were addressed by Dr. Bridger.
B. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Board Comments
No additional comments given.
IX. Adjournment
A motion was made by Nick Galvez to adjourn the meeting at 8:20 p.m., was seconded by
Susan Elmore and carried without dissent.
The next Board of Health Meeting will be held March 23, 2016 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Colleen Bridger, MPH, PhD
Orange County Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: March 23, 2016
Agenda Item Subject: 2015 Community Health Assessment Update and Document
Review
Attachment(s): 2015 Orange County Community Health Assessment, 2015 Orange
County Executive Summary, Community Health Assessment Presentation
Staff or Board Member Reporting: Ashley Mercer
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information: Every 4 years, the Health Department and Healthy Carolinians
conducts a Community Health Assessment to enable public health officials to monitor
trends in health status, determine priorities among health issues, and determine the
availability or resources in Orange County.
With the overall goal to address health disparities and identify needs of populations who
are most disadvantaged, 799 survey households were randomly selected from census
blocks, 279 address were attempted and 166 door-to-door surveys were completed.
New to this CHA, a health opinion survey was placed online and completed by 1,548
community residents. Combined, this created 1,714 total health opinion surveys
answered, 5 focus groups conducted, and 4 community listening sessions held.
The results from the 4 community listening sessions were brought to HCOC’s Annual
Meeting were participants prioritized issues on the basis of importance and
changeability. The chosen health priorities were 1) Social Determinants of Health with
priority around Access and Poverty, 2) Mental Health &Substance Abuse, and 3)
Physical Activity & Nutrition.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
2015 ORANGE COUNTY
COMMUNITY HEALTH ASSESSMENT
FULL REPORT
Submitted to the Division of Public Health, North Carolina Department of Health and Human
Services by the Orange County Health Department and Healthy Carolinians of Orange County.
Physical Activity & Nutrition Chronic Disease
Tobacco
Mental Health
Oral Health
Substance Abuse
Injury & Violence
Environmental Health
STD’s & Unintended Pregnancy
Maternal & Infant Health
Infectious Disease Social Determinants of Health
2015
Community
Health
Assessment
Orange County, NC
Submitted to the North Carolina
Department of Health and Human Services
Division of Public Health
By the Orange County Health Department
and Healthy Carolinians of Orange County
i
Table of Contents
Table of Contents ............................................................................................................................... i
List of Charts and Figures ................................................................................................................... iv
Acknowledgements ............................................................................................................................ vii
Executive Summary ............................................................................................................................ viii
Background ........................................................................................................................................ 1
County Description ............................................................................................................................ 3
Community Priorities ......................................................................................................................... 7
Social Determinants of Health ............................................................................................. 7
Poverty ..................................................................................................................... 7
Employment Rate .................................................................................................... 8
Poverty Mitigation .................................................................................................. 8
Poverty Mitigation Population Health Dashboard................................................... 10
Access ................................................................................................................................... 11
Access to Health Care ............................................................................................. 11
Access to Health Insurance ..................................................................................... 12
Access to Dental Care ............................................................................................. 13
Access to Transportation ......................................................................................... 14
Access to Health Literacy ......................................................................................... 15
Access to Care Population Health Dashboard ........................................................ 16
Access to Care Current Initiatives and Activities ..................................................... 17
Mental Health and Substance Abuse .................................................................................. 18
Mental Health ......................................................................................................... 18
Suicide ...................................................................................................................... 18
Alcohol .................................................................................................................... 19
ii
Betel Nut ................................................................................................................. 20
Poisoning ................................................................................................................. 20
Tobacco ................................................................................................................... 21
Mental Health and Substance Abuse Population Health Dashboard .................... 23
Tobacco and Respiratory Population Health Dashboard ........................................ 24
Mental Health and Substance Abuse Current Initiatives and Activities ................. 25
Physical Activity, Nutrition and Healthy Weight .................................................................. 26
Physical Activity and Nutrition ................................................................................ 26
Healthy Weight ....................................................................................................... 27
Nutrition in Schools ................................................................................................. 27
Physical Activity and Nutrition Population Health Dashboard ................................ 28
Physical Activity and Nutrition Current Initiatives and Activities ............................ 29
Leading Causes of Death and Disease ................................................................................................ 30
Leading Causes of Death ....................................................................................................... 30
Chronic Disease ..................................................................................................................... 31
Cancer ................................................................................................................................... 31
Controllable Factor Health Screenings ................................................................................. 32
Stroke .................................................................................................................................... 32
Heart Disease ........................................................................................................................ 33
Diabetes ................................................................................................................................ 33
Communicable Diseases .................................................................................................................... 34
Influenza................................................................................................................................ 35
Vaccine Preventable Diseases ............................................................................................... 35
Sexually Transmitted Diseases .............................................................................................. 35
Communicable Disease Current Initiatives and Activities .................................................... 37
iii
Social Determinants of Health ........................................................................................................... 38
Education and Racial Equity .................................................................................................. 38
Injury and Violence ............................................................................................................... 40
Food Insecurity and Financial Assistance .............................................................................. 41
Affordable Housing ............................................................................................................... 42
Homelessness ....................................................................................................................... 43
Social Determinants of Health Current Initiatives and Activities ......................................... 44
Maternal and Infant Health ............................................................................................................... 45
Teenage Pregnancy ............................................................................................................... 45
Infant Mortality ..................................................................................................................... 46
Infant Health ......................................................................................................................... 46
Maternal and Infant Health Current Initiatives and Activities .............................................. 47
Environmental Health ........................................................................................................................ 48
Air Quality ............................................................................................................................. 48
Drinking Water Quality ......................................................................................................... 49
Water Supplies ...................................................................................................................... 49
Lead Hazards ......................................................................................................................... 50
Environmental Health Current Initiatives and Activities ...................................................... 51
Appendix
iv
List of Figures and Tables
Figure 1: Orange County Population Growth .................................................................................... 3
Table 1: Orange County General Population Compared to Peer Counties and NC ........................... 4
Figure 2: Orange County Race & Ethnicity ......................................................................................... 4
Figure 3: Orange County Age ............................................................................................................. 4
Table 2: Direct Refugee Arrivals, Orange County, NC ........................................................................ 5
Table 3: Primary Languages Spoken by LEP Residents in Chapel Hill and Carrboro .......................... 5
Figure 4: Orange County Areas of Concentrated Poverty ................................................................. 7
Table 4: Orange County and NC Populations Living Below the Poverty Level ................................... 8
Figure 5: Map of Two Geographic FSA Zones in Orange County ....................................................... 9
Figure 6: Reasons for Trouble Getting Medical Care for Child(ren) .................................................. 11
Figure 7: Percent Uninsured by Age and Income Status ................................................................... 12
Figure 8: County and State Affordable Care Act Year-to-Year Enrollment ........................................ 12
Figure 9: Places Respondents had Trouble Getting Medical Care ..................................................... 13
Figure 10: Resident access to medical facilities and bus stops in Orange County............................. 14
Figure 11: Where Survey Respondents Reported Getting their Health Related Information ........... 15
Figure 12: Where Survey Respondents Would Refer a Friend who had a Mental Health Problem .. 18
Figure 13: Circumstances of Suicide: Orange County, NC ................................................................. 19
Figure 14: Manner of Death by Sex, Orange County, NC ................................................................... 19
Figure 15: Crashes that Involved Alcohol, 2009-2013 ....................................................................... 20
Figure 16: Orange County Opiate Poisoning Deaths, 2005-2014 ...................................................... 21
Figure 17: Locations Survey Respondents are Exposed to Secondhand Smoke ................................ 21
Figure 18: High School Current Smoking and Tobacco Use, 1999-2013 ............................................ 22
Figure 19: Reasons Why Survey Respondents Don't Exercise .......................................................... 26
Figure 20: BMI among survey respondents ....................................................................................... 27
v
Table 5: Students receiving free or reduced lunch ...................................................................... 27
Figure 21: Leading Causes of Death, 2010 – 2014, Age-Adjusted Mortality Rates per 100,000 ....... 30
Table 6: Leading Causes of Death by Age Group ............................................................................... 30
Figure 22: I have been told by a doctor that I have..... ...................................................................... 31
Figure 23: Orange County 2013 Cancer Deaths by Site ..................................................................... 31
Figure 24: Survey Respondents Self-Reported Health Screenings .................................................... 32
Figure 25: Age-Adjusted Stroke Death Rates per 100,000 Residents ................................................ 32
Table 7: Orange County Heart Disease Deaths from 2013 - 2014 ..................................................... 33
Figure 26: Heart Disease Mortality Rates per 100,000 People .......................................................... 33
Figure 27: Age-Adjusted Diabetes Death Rates per 100,000 People................................................. 33
Table 8: Reported Communicable Diseases and Conditions in Orange County by Year ................... 34
Table 9: Sexually Transmitted Disease Cases among Orange County Residents by Year .................. 35
Figure 28: North Carolina Newly Diagnosed HIV Infection Rates ...................................................... 36
Figure 29: Education Attainment ....................................................................................................... 38
Table 10: 2015 Average SAT Scores ................................................................................................... 38
Figure 30: Chapel Hill-Carrboro City Schools EOC Test Results ......................................................... 39
Figure 31: Manner of Death, Orange County, NC .............................................................................. 40
Figure 32: Manner of Death by Race, Orange County, NC ................................................................ 40
Figure 33: Population with Limited Food Access, Low Income, Percent by Tract ............................. 41
Table 11: Income and Hourly Wage Needed to Afford a 2 Bedroom Apartment ............................. 42
Table 12: Orange County Homeless persons by Family Structure ..................................................... 43
Figure 34: North Carolina Homelessness, 2014 ................................................................................. 43
Figure 35: Improvement in Teen Pregnancy Rate ............................................................................. 45
Table 13: Teen Pregnancies within Orange County and NC, 2014 .................................................... 45
Figure 36: 2014 Infant Mortality (per 1,000 live births) .................................................................... 46
vi
Figure 37: Orange County vs. NC Melanoma Incidence .................................................................... 48
Figure 38: Melanoma Incidence by Gender ....................................................................................... 48
Table 14: Number of New Wells and Water Samples Collected Over a 3-Year Period ..................... 49
Table 15: Number of Children under the Age of 6 with a Blood Lead > 10 ug/dL ............................. 50
vii
Acknowledgements
The Orange County Health Department and Healthy Carolinians of Orange County would like to say
thank you to the many individuals and groups for their assistance during the course of the 2015
Community Health Assessment (CHA) process. Whether you answered a survey, volunteered to
administer door-to-door surveys, attended a community listening session, was a participant in a focus
group, helped spread the word of the process to those in your community or workplace, or responded
to a CHA request, this assessment could not have been successful if it were not for you.
The goal of this document is to publish a report that is easy to navigate and enables the reader to
quickly locate information on a topic of interest. In the electronic version, internal and external links are
identified to ease movement through and beyond the document. Internal links are underlined in green
font and external links are underlined in blue font.
Thank you to the volunteers who conducted the door-to-door CHA surveys and to Care Share Health
Alliance for providing technical assistance and facilitation efforts for focus groups during the data
collection process. Because of your help, the voices of community members were heard throughout the
entire process.
The 2015 CHA assessment process and report document was coordinated and compiled by Ashley L.
Mercer, MPH, Healthy Carolinians Coordinator and Senior Public Health Educator for the Orange County
Health Department. The CHA was reviewed and or provided information by a number of committee
members and public health professionals, such as:
• Alan Clapp, Orange County Health Department
• Allison Young, Orange County Health Department
• Brian Carson, Orange County Planning Department
• Carla Julian, Orange County Health Department
• Coby Jansen Austin, Orange County Health Department
• Donna King, Orange County Health Department
• Dr. Colleen Bridger, Orange County Health Director
• Judy Butler, Orange County Health Department
• Katrice Perry, North Carolina Central University
• Krista Ragan, United Way of the Greater Triangle
• LaToya Strange, Orange County Health Department
• Liska Lackey, Orange County Board of Health
• Madelyn Davis, Orange County Health Department
• Marni Holder, Piedmont Health Services
• Meredith Stewart, Orange County Health Department
• Micah Guindon, Orange County Department of Social Services
• Michael Verville, The Alliance for Historic Hillsborough
• Mike Fliss, Orange County Resident
• Nidhi Sachdeva, NC Department of Health & Human Services
• Scott Proescholdbell, NC Department of Health & Human Services
• Sherry Hay, UNC Family Medicine
• Stacy Shelp, Orange County Health Department
• Susan Clifford, Orange County Health Department
viii
Executive Summary
Introduction
Every 4 years, the Orange County Health Department and Healthy Carolinians of Orange County (HCOC)
conducts a Community Health Assessment (CHA). Regular assessment of Orange County’s health
enables public health officials to monitor trends in health status, determine priorities among health
issues, and determine the availability of resources within Orange County to best protect and promote
the public’s health.
With the overall goal to address health disparities and identify needs of populations who are most
disadvantaged, 799 survey households were randomly selected from census blocks, stratifying to ensure
low-income communities were included. 279 addresses were attempted and 166 door-to-door surveys
were completed. New to this CHA, a health opinion survey was placed online and was completed by
1,548 community residents. Combined, this created 1,714 total health opinion surveys answered, 5
focus groups conducted, and 4 community listening sessions held.
Selected Priorities
The results from community listening sessions were brought to HCOC’s Annual Meeting in December
2015 where participants prioritized issues on the basis of importance and changeability. The health
priorities, as determined by Annual Meeting participants to be of greatest concern to the Orange County
community, were 1) Social Determinants of Health with priority around Access and Poverty, 2) Mental
Health & Substance Abuse, and 3) Physical Activity and Nutrition.
Poverty
Orange County has the highest Gini Coefficient of Income Inequality in NC (0.52). This means our county
experiences high income dispersion, where fewer people hold a lot of capital and many people hold
little capital.
While the median income for households in Orange County is $57,261, 17% of residents are living in
poverty, including 16% of children.
Food insecurity and affordable housing are key areas of emphasis for mitigating the effects of
poverty in Orange County.
While Orange County’s median gross rent is $918 half of Orange County households (52.7%) who
rent spend more than 30% of income on rent.
21% of children and 15.4% of the overall population (20,900 people) live in food insecure
households in Orange County
Access
Approximately 21,000 Orange County residents, between 0-64 years of age are uninsured.
Low income residents are twice as likely to be uninsured compared to the average county
resident.
In 2013 a higher percentage of low income youth under 19 years were uninsured in Orange
County [15% (+/- 3.2%], and 31.8% of low income residents under 64 years were uninsured.
Over 6,000 Orange County residents enrolled into the marketplace for 2015 coverage.
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Transportation
3,000 individuals in Orange County with no vehicle live outside of the walkable/ridable coverage
area to medical clinics.
Mental Health and Substance Abuse
Mental health refers to a wide range of conditions that affect one’s mood, thinking and behavior. Broad
classes of mental illness include mood disorders (depression, bipolar disorder), eating, personality,
anxiety and psychotic disorders (schizophrenia), and addictive behaviors/substance abuse disorders.
Orange County has a suicide rate of 10.4 per 100,000 people.
Females (23%) are more likely to attempt suicide when compared to males (16%).
54% of female and 46% of male suicide victims had a mental health problem.
6% of Orange County motor vehicle crashes are alcohol related.
8% of Orange County adults and 9% of high schoolers drove after drinking in the past 30 days.
Overall tobacco use in increasing, driven in large part by use of e-cigarettes and hookah.
Almost 4 out of 10 high school students, in Orange County, have tried an e-cigarette and about 2
out of 10 of high school students currently use them.
Physical Activity and Nutrition
According to national surveys, adults show negative trends in both physical activity and
nutrition.
Student fruit and vegetable consumption is improving compared to previous years; however,
Orange County still performs worse than the US.
45% of high schoolers do not eat one or more servings of fruits and vegetables a day. National
recommendations far exceed one serving each of fruits and vegetables per day, meaning many
more students likely still do not meet national recommendations.
75.4% of adults do not eat 5+ fruits or veggies per day.
43.2% of adults did not meet aerobic nor strengthening guidelines.
14% of low income preschool children are obese.
78% of high schoolers do not get 60 minutes of exercise per day.
Chronic Disease
While chronic diseases are the leading causes of death in Orange County, lack of physical activity and
not eating healthy contributes heavily to the incidence of chronic disease.
While the number of deaths due to disease of the heart has increased in the past 3 years, the
age-adjusted mortality rate has been declining; implying heart disease mortality is generally
improving or stable. However, prevalence of chronic diseases, such as Cardiovascular Disease
and Diabetes has increased in the last decade.
More than half of all deaths in Orange County (52%) are caused by cancer, diseases of the heart,
or chronic respiratory diseases.
Nearly 50 million dollars was spent on cardiovascular and circulatory disease inpatient visits in
Orange County in 2013, accounting for 16% of all condition costs.
x
Next Steps
Findings from this CHA report will help influence strategic planning across the community. HCOC will
assure broad dissemination of the full report so that entities contributing to the health of Orange
County residents can develop new or modify existing programs, services, and resources to address the
community health needs relevant to their stated missions.
It is hoped that this 2015 CHA report and its follow-up activities will be of use to community members
and service providers alike, for all are working towards the common goal of making Orange County a
healthy place to live, work, play and pray.
1
Background Introduction
Every 3-4 years, Local Health Departments conduct a Community Health Assessment (CHA). Regular
assessment of a community’s health enables local public health officials to monitor trends in health
status, determine priorities among health issues, and determine the availability of resources within the
community to best protect and promote the public’s health. A primary goal of the assessment process is
to involve the community in every phase of the assessment, including planning, data collection,
evaluation, identification of health issues and community strengths, and the development of strategies
to address identified problems.
The Assessment Process
Four CHA teams were created to assist in the 2015 CHA process and included: 1) a
CHA Leadership Team (CHALT), the governing body and final decision makers, 2)
the Communication Team, 3) the Community Engagement Team, and 4)
the Data Team. Community partners were key to the overall survey effort,
including serving on CHALT, coordinating focus groups and publicizing the
survey (see Appendix C: Team Members)
Data Collection and Analysis
This report was created using both primary (community input) and
secondary (previously collected) data sources. Primary data was
collected through community health opinion surveys (door-to-door and
online), partner surveys, focus groups and community listening sessions.
Using both primary and secondary data yields a more in-depth and reliable
assessment of the specific factors that affect our community’s health.
With the overall goal to address health disparities and identify needs of populations who are most
disadvantaged, 799 survey households were randomly selected from census blocks, stratifying to ensure
low-income communities were included. 279 addresses were
attempted and 166 door-to-door surveys were completed,
compared to 160 door-to-door surveys in 2011. New to this CHA,
a health opinion survey was placed online and was completed by
1,548 community residents using a non-random, snowball
approach of sharing the link with partner organizations and
mailing lists. Combined, this created 1,714 total health opinion
surveys answered.
Attempts to recruit selected households and administration of
surveys were carried out by a team of 86 volunteers over a
course of three survey weekends (8 days) within two months. All
volunteers participated in a mandatory training which covered
safety plans and procedures for conducting surveys (e.g.
techniques for conducting unbiased surveys, what to do if
someone was not home or chose not to participate, procedures
for non-English speaking residents, etc.). Volunteers conducted
surveys in teams of two, and each team was assigned a specific
2
list of addresses grouped by proximity. Households were given the option to provide a phone number
to complete the survey over the phone or given a link to complete the survey online at a later time if
more convenient. All survey respondents who completed a door-to-door survey were given a small
incentive for their participation.
A 50-question survey was developed and administered (door-to-door) based on standardized questions
representing the 13 Healthy North Caroliana 2020 focus areas: Tobacco, Physical Activity and Nutrition,
Injury and Violence, Maternal and Infant Health, Sexually Transmitted Diseases and Unintended
Pregnancies, Substance Abuse, Mental Health, Oral Health, Environmental Health, Infectious Disease
and Foodborne Illness, Chronic Disease, and Social Determinants of Health. The survey was
administered by hand and entered into EpiInfo version-7software. A flash drive was used to merge the
data from multiple input devices onto one computer and analyzed through Microsoft Access. Online
health opinion and partner surveys were administered and analyzed through Survey Monkey. All data
was combined and analyzed through custom formulas and reports, comparing all question responses
against multiple categories of age, race/ethnicity, and gender. Community findings and responses are
presented throughout the document under the Survey Data heading inserts.
Focus Groups
Five focus groups (55 voices) were conducted between July and September among populations that are
at-risk and/or under-represented to gain more in-depth understanding of what health concerns are
experienced in Orange County. Focus group questions were broad and explored important aspects of
good health, community strengths, and barriers to good health, with follow up questions and prompts
tailored for each group. Focus groups were conducted in partnership with Bridging the Gap CDC, the
Family Success Alliance, Chapel Hill – Carrboro City Schools, the Latino Health Coalition and the Refugee
Health Coalition, and were conducted among older African Americans, Hispanic/Latino, Refugees from
Burma, youth and low-income African Americans.
Focus group participation was recruited from existing networks and relationships with relevant agency
providers. Each focus group was led by a trained facilitator and notes were taken by an informed
notetaker. All focus groups were digitally recorded and transcribed, and all comments were helpful in
highlighting gaps, specific concerns, and providing richness to the overall data results. Community
findings and responses are presented throughout the document under the Focus Group heading inserts.
Spreading awareness of both online and door-to-door surveying and community listening sessions was
created through: electronic emailing, address mailing, local media outlets (newspapers, radio), Healthy
Carolinians of Orange County, community listserv’s, Orange County Government, social media, Chapel
Hill – Carrboro Chamber of Commerce, UNC Hospital, community newsletters, various community
coalitions and partnerships, county agencies and organizations, CHA specific committees, Orange
County Board of Health, and the Orange County Board of County Commissioners.
Subject Matter Experts
Agency and subject matter partners completed a short survey on their experiences and expert opinions
on the Healthy NC 2020 content areas. Twenty local partners completed the survey in response to how
their agencies/organizations are addressing the needs of residents as they pertain to specific health
concerns. In addition, they discussed any barriers and/or trends they have observed in their field of
expertise. Partner findings and responses are presented throughout the document under Subject
Matter Expert heading inserts.
3
County Description
Orange County is a diverse vibrant community centrally
located between the Research Triangle Park and the Triad
(Greensboro, Winston-Salem and High Point) with
Interstates 85 and 40 providing primary transit linkages.
With a population of approximately 140,000 people,
Orange County includes historic Hillsborough, the county
seat; Chapel Hill, home of the University of North Carolina
(the oldest state-supported university in the United
States); Carrboro and parts of Mebane, both of which are
former railroad and mill towns. The diversity of our
people make the county interesting and lively - dairy
farmers and professors; small business people and
corporate executives; developers and horse breeders;
resettled refugees and students.
In 2015, we ranked number one in the state for the first
time for both Health Outcomes and Health Factors
according to the County Health Rankings. As in other
parts of North Carolina (NC) and the United States (US),
health status depends in part on where one lives and their racial, ethnic, and economic status. Orange
County is governed by a seven-member board of commissioners who are elected to four-year terms by
district and at-large in partisan elections.
General Population
The population of Orange County has more than doubled in the past four decades, with a population
increase of 5% since 2010 and a 19% increase since 2000 (shown in figure 1).
Figure 1: Orange County Population Growth
1940-2020*
1940 1950 1960 1970 1980 1990 2000 2010 2020
154,000
23,072 34,445 42,970
57,707
77,055
93,851
115,531
133,702
140,420
*Projected
Year
4
71%
11%
1%
7%
0%
2%
8%
Race and Ethnicity
White alone
Black or African American
alone
American Indian and Alaska
Native alone
Asian alone
Native Hawaiian and Other
Pacific Islander alone
Two or More Races
Hispanic or Latino
Table 1: Orange County General Population Compared to Peer Counties and NC1
People
Orange
County
Brunswick County
(Peer County)
New Hanover
County
(Peer County)
North
Carolina
Population, 2014
estimate
140,420 118,836 216,298 9,943,964
Population, % change
(April 2010 to July 2014)
5.0% 10.6% 6.7% 4.3%
Persons under 5 (2014) 4.7% 4.5% 5.3% 6.1%
Persons under 18 (2014) 20.4% 17.2% 19.4% 23.0%
Persons 65 and over
(2014)
11.2% 27.0% 15.8% 14.7%
Female Persons (2014) 52.2% 51.4% 52.0 51.3%
In terms of where people reside, according to the 2010 Census, 71.5% of Orange County residents live in
the southern “urban” areas of Chapel Hill and Carrboro, while the remaining 28.5% live throughout the
rural areas of the County.2
The largest minorities differ in the three main municipalities. Black residents are the largest group of
minorities in Hillsborough making up 30%; in Carrboro the largest group is Hispanic or Latino residents
making up 14%; and in Chapel Hill the largest minority group is Asian making up 12%.3 Figures 2 and 3
provide a representation of the county’s race and ethnicity, and age breakdown.
Figure 2: Orange County Race & Ethnicity 4 Figure 3: Orange County Age5
5
Immigrant and Refugee Populations
Orange County’s foreign born population (13%) continues to be concentrated in the southern part of the
county, with Hispanic/Latino and Asian immigrants/refugees as the majority. The Hispanic/Latino
immigrant population is mostly from Mexico, with smaller percentages from Central and South America;
while the Asian immigrant population is mostly from China, followed by India, Korea and Burma. In
Carrboro, where the foreign-born population is the largest (20.1%), there are higher concentrations of
refugees from Burma, while Chapel Hill has higher concentrations of Asian Indian and Korean
immigrants6. For many years, we have mostly resettled refugees from Burma, representing ethnic
Burmese, Karen, Chin and additional ethnic groups of various cultures and languages (see table 2).
Table 2: Direct Refugee Arrivals, Orange County, NC7
Fiscal Year New Direct Refugee Arrivals Countries of Origin
2005-2006 19 14 Burma, 4 Cuba, 1 Iran
2006-2007 55 55 Burma
2007-2008 255 248 Burma, 4 Colombia, 3 Iran
2008-2009 194 181 Burma, 6 Bhutan, 4 Iran, 3 Iraq
2009-2010 57 54 Burma, 2 Congo, 1 Haiti
2010-2011 86 78 Burma, 8 Laos
2011-2012 53 53 Burma
2012-2013 83 78 Burma, 5 Congo
2013-2014 80 79 Burma, 1 Cameroon
2014-2015 54 44 Burma, 3 Congo, 3 Nepal, 3 Iraq, 1 Iran
TOTAL 936 Total from Burma: 884
With diverse ethnicities and countries of origin, Orange County also experiences linguistic diversity and
varied levels of English proficiency within its residents. Over 16% of county residents speak a language
other than English at home, with 37.4% of those speaking English “less than very well.” Most Limited
English Proficient (LEP) residents live in Carrboro or Chapel Hill and are either Spanish-speakers or
speakers of Asian languages (see table 3). Orange County anticipates several dozen Syrian refugees and
potentially more refugees from the Democratic Republic of the Congo in the coming year.
Table 3: Primary Languages Spoken by LEP Residents in Chapel Hill and Carrboro 8
Language Spoken at Home % Carrboro LEP Residents % Chapel Hill LEP Residents
Spanish 65.3% 34.0%
Asian Languages 29.0% 46.6%
6
Geography
Orange County covers nearly 400 square miles, or 254,720 acres of rolling farms and forest, urban
centers and small towns, with an average 336 persons per square mile. The County is comprised of three
incorporated municipalities: the Town of Chapel Hill is the largest with a population of 59,376; Carrboro,
adjacent to Chapel Hill has a population of 20,984; Hillsborough, the county seat, has a population of
6,388; and a portion of the City of Mebane (which is mostly in Alamance County) has a population of
1,903.
History
Originally home to a succession of Native American tribes that
included the Haw, Eno, Occaneechi, and others, the area
including what is now Orange County covered 3,500 square
miles. This large area also included all of present day Alamance,
Caswell, Person, Durham, and Chatham counties as well as parts
of Wake, Lee, Randolph, Guilford and Rockingham counties.
On September 9, 1752, following English settlement, Orange
County was founded and named after William V of Orange and
King William III of England. County boundaries have changed
considerably since the 1750s. The county seat for Orange is
Hillsborough, founded in 1754 and first called Corbin Town, then Childsburgh, and in 1766 the town’s
final name became Hillsborough. Hillsborough is an old and interesting town located on land where the
Great Indian Trading Path crossed the Eno River and was the center of much colonial activity. The
County is divided into the seven townships of Bingham, Cedar Grove, Chapel Hill, Cheeks, Eno,
Hillsborough, and Little River9.
Land Use
Forest land is the predominant land use within the county, followed by farmland, though both are
rapidly disappearing as low density residential land use continues to expand. According to recent
Commission for the Environment reports, urban sprawl is an increasing problem within Orange County
and we are a part of the Triangle region of NC which has been rated as having the third highest
incidence of urban sprawl in the nation.
Faith and Spirituality
There are over 600 places of worship located in Orange County, to include churches, mosques,
synagogues and other faith organizations. These institutions provide a source of spiritual nourishment,
community support and resources to the residents of Orange County. As residents face the challenge of
trying to stay connected to their community in an area where the population is growing and changing
quickly, their spiritual homes become sources of social interaction, information exchange, and even
health care.
7
Social Determinants of Health
1) Social Determinants of Health, 2) Mental Health & Substance Abuse and 3) Physical Activity &
Nutrition are Orange County’s three chosen priority areas for 2015-2019. Access and poverty were the
highest ranked social determinants and will be the focus of this section. You may find other social
determinants in the Social Determinants of Health section.
v
According to income inequality measures, wealth in Orange County is not evenly distributed across
resident populations, and health inequities persist due to differences in educational and economic
opportunities.
While the county’s median household income ($57,261) is above the state ($46,693) and national
average ($53,482), this number hides pockets of poverty.
The current 2014 poverty rate in Orange County is 16.8%—down from 17.4% in 2012, with child
poverty at 15.7%.
Adult poverty rates differ by ethnic group with Black (26.7%) and Hispanic (34.1%) residents being
more likely to live in poverty than their White (14.8%) or Asian (11.7%) counterparts.
Poverty guidelines are identified based on family size and income to determine various purposes such as
financial eligibility for federal programs. Programs that use poverty guidelines (or percentage multiples
of the guidelines —125%, 150%, or 185% of the guidelines) in determining eligibility include but not
limited to: Head Start, the Food Stamp Program, the National School Lunch Program, the Low-Income
Home Energy Assistance Program, the Children’s Health Insurance Program, and Community and
Migrant Health Centers.
hldhdv
In January 2014, the Orange County Health Department (OCHD)
responded to a question about the state of child poverty in
Orange County. 17% of Orange County children are estimated to
be below the federal poverty level as of 2013, representing a 7%
increase from 2001. In particular, children who have adverse
childhood experiences (ACEs) that are more common among
families experiencing poverty are at higher risk of health
outcomes like obesity, depression, and substance abuse.
Few publicly available sources exist to map poverty estimates at
the neighborhood level, and many sources of poverty-related
data are imperfect when taken individually. Therefore, OCHD
staff identified pockets of low-income populations (see figure 4)
using four different data sources that suggest low-income: (1)
residential structure type from the Land Records/GIS, (2) active
housing choice vouchers from Housing, (3) children on Medicaid
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cadv
8
from the Department of Health and Human Services and (4) clinic patients from the health department.
OCHD staff developed an aggregate indicator measuring the likelihood of a neighborhood being low-
income, scoring from 0 to 4 (most likely low-income neighborhood). This score is calculated for every
1/4 mile block in Orange County, for blocks with more than 30 residential addresses of any type. From
this analysis, six poverty zones were identified based on 1) the concentration of areas scoring high on
the Poverty Index and 2) proximity to schools.
The age and gender distribution of Orange County and NC populations living below the poverty level are
considerably lower compared to data expressed from 2010. In all categories, except 18 to 64 years,
Orange County shows the percent of the population living below the poverty level is lower than NC (see
table 4).
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7.5% of residents in the civilian labor force are unemployed compared to 10.5% of the civilian labor
force in NC.
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The Health Department, community leaders, and families know that health is not just what happens
inside a clinic. A child’s health is linked directly to
their earliest family and community experiences,
how well they do in school, and their health and
income decades after graduation.
Decades of research show that the more adverse
events a child experiences in their earliest years, the
more likely they are to experience chronic diseases,
mental health issues, and behaviors that lead to teen pregnancy or the contraction of sexually
transmitted diseases later in life10. Adverse experiences range from physical, emotional, or sexual abuse
to parental divorce or substance abuse by a parent11. Over half of North Carolinians surveyed during the
2012 Behavioral Risk Factor Surveillance System Survey reported experiencing ACEs, and those who
reported higher numbers of ACEs were more likely to be low-income, have less than a high-school
education, and be unemployed12.
Tabl 4:OagadN plaLvgBlw
hvLvl
%BlwvLvl
Oag Nhala
Population for whom poverty status is determined 16.8% 17.6%
Ag
Under 18 years 15.7% 25%
18 to 64 years 19% 16.5%
65 years and over 5.9% 9.9%
Gd
Male 14.9% 16.1%
Female 18.6% 18.9%
“Children living in poverty are much more likely to
experience adverse childhood events such as abuse,
neglect, or a general category of household
dysfunction.
- Dr. Colleen Bridger, Orange County Health Director
9
While poverty cannot be solved with a silver bullet, we can mitigate the effects of poverty on children
with strategies that create a seamless pipeline of services and supports from cradle to college and
career. To do this in Orange County, a collaborative group of local government, non-profits, schools,
and community members called the Family Success Alliance (FSA) was formed in 2014 to work towards
an Orange County where all children and families have the opportunity to succeed in school and in life.
Starting in two geographic “zones” in Orange County (figure 5), the FSA is working to strengthen the
pipeline of high-quality, connected health, education, and family support systems to make sure all
children are healthy and prepared for school, are healthy and succeed in school, graduate from high
school and college, and that family and neighborhoods can support their healthy development. This
work is based on national models such as the Harlem Children’s
Zone and the Promise Neighborhoods.
In 2015 and 2016 FSA started a kindergarten readiness program and
served 66 families in three zone elementary schools, developed a
joint intake and referral system with partner organizations, and
provided one-on-one family support from family coaches with lived
experience in our zones, called Zone Navigators. Students in the
kindergarten readiness program showed significant growth, with 9%
of students assessed with a proficient level of readiness at the start
of the program and 67% with a proficient level of readiness at the
end of the program according to measures from the Kindergarten
Readiness Assessment. Work with the FSA collaborative of agencies
has also resulted in improvements in understanding, collaboration,
and coordination between agencies serving children and families in
the zones. This has included scheduling and location of
programming, the content of services, and the communication
between providers.
Moving forward into 2016, FSA will expand the kindergarten
readiness program to include 90 incoming kindergarteners,
continue support from Zone Navigators, and work with partners to
strengthen programs and services.
Figure 5: Map of Two Geographic FSA
Zones in Orange County
10
Orange County, NC
2016 Population Health Dashboards
Summary:
Orange County has the highest Gini Coefficient of Income Inequality in North Carolina (0.52). This means our county
experiences high income dispersion, where fewer people hold a lot of capital and many people hold little capital.
While the median income for households in Orange County is more than $57,000, 17% of residents are living in
poverty, including 16% of children. Food insecurity and affordable housing are key areas of emphasis for mitigating
the effects of poverty in Orange County. The Family Success Alliance is one example of an initiative working in two
neighborhood zones experiencing higher rates of poverty than the county as a whole. Up to 25% of families in Family
Success Alliance zones experience the negative effects of poverty on health and well-being.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Family Success Alliance: Zone 4
25% of Families in Zone 4 experience Poverty
Family Success Alliance: Zone 6
22% of Families in Zone 6 experience Poverty
Social and Economic Determinants of HealthSocial and Economic Determinants of HealthSocial and Economic Determinants of HealthSocial and Economic Determinants of Health
IconCurrentTargetPreviousProgressPeerNCUS
% Population living in Poverty17%13%18%SAME 16%18%16%
% Children <18 living in Poverty16%NA 17%SAME 23%25%22%
% Households on SNAP benefits8%NA 8%SAME 12%14%13%
% Unemployed 8%NA 8%SAME 8%11%9%
% Population that is Food Insecure14%6%NA -16%17%15%
% Children Eligible for Free or Reduced Lunch34%NA 34%SAME 49%53%48%
% Renters paying >30% Income on Rent53%36%54%SAME 50%57%52%
4 year Graduation Rate (%)88%95%83%↑85%86%81%
Gini Coefficient of Income Inequality
(0= most equal, 1.0 = least equal)0.52 NA 0.53 SAME 0.450.470.48
Progress Orange County TrendCompare to
Data Notes: See the Public Health Dashboard FAQ Document for more on data methodology.
Sources: ACS, UNC School of Government, NC Public Schools, NCES
Data points are the most current measures from multiple sources (available on request).
11
Access
Access to Health Care
The ability to access quality and affordable health care services is a key component in a person’s overall
health. According to Healthy People 2020, health care access is defined as “…timely use of personal
health services to achieve the best health outcomes.”13 Health care access impacts a person’s quality
and quantity of life as it dictates when and how often a person can use the health care system to obtain
preventive, diagnostic, and treatment services.
Orange County has a strong health care community that includes a nationally-ranked hospital system, an
accredited School of Public Health, a federally qualified health center, a local public health department,
a medical and dental school and various private medical practices. In spite of these resources, residents
report problems accessing health care services. In addition to medical insurance, factors contributing to
a resident’s inability to access health care services include the concentration of health care resources in
the southern part of the county, inadequate transportation systems in the central and northern part of
the county, language barriers, and perceived discrimination (or racism) within health care facilities.
Orange County has a physician rate of 105.4 physicians (an increase from 93.6) per 10,000 people
that far exceeds NC (22.7) and the US (22.5).
As shown in figure 6, 18% of survey respondents, with children, report not having insurance for their
children.
Immigrant and Refugee Populations
NC Minority Health data show that health disparities and inequities persist for immigrant and refugee
children and adults alike. Compared to whites, NC Hispanic parents are more likely to report that their
children have fair or poor general and dental health, are uninsured, don’t have access to a regular
dentist and are classified as overweight or obese.14 Hispanics in NC also suffer disproportionally from
late or no prenatal care, high teen birth and poverty rates, and a high uninsured percent compared to
whites.15 Unfortunately data specific to Asian populations are not available currently due to unreliable
population estimates and data limitations.
Immigrant and refugee focus group respondents experience barriers when it comes to access to
care, in particular the inability to get timely access to affordable, high quality medical and dental
care, which often results in self-medication or avoidance of the system.
2%
7%
9%
18%
30%
34%
0%10%20%30%40%
There are no doctors in my community
It's too hard to get to a doctor's office
The doctors have strict late or "no-show" policies that…
My children don't have health insurance
The hours and days they are open are not convenient
The doctors don't accept Medicaid
Figure 6: Reasons for Trouble Getting Medical Care for Child(ren)
12
Latino immigrant focus group respondents experience a lack of appointments for men, frustration
with lack of response and long wait times when seeking service.16
Access to Health Insurance
According to 2013 small area health insurance estimates (SAHIE) approximately 21,000 (15.3%)
Orange County residents between 0-64 years of age were uninsured, a decrease from 2011 where
16.4% of residents were uninsured (see figure 7).
Orange County generally has comparable rates of uninsured residents to the state; however in 2013,
a higher percentage of low income youth under 19 were uninsured in Orange County (15% +/- 3.2%)
as compared to NC (9.2% +/- 0.7%)17.
In 2010, the Patient Protection and Affordable Care Act were enacted by Congress to reduce the number
of uninsured Americans by providing affordable, high-quality health insurance.18 NC, a Federally-
Facilitated Marketplace (FFM) state, enrolled 28% of new consumers and 72% of re-enrollees during the
2016 plan selection, which could account for the decrease in our uninsured rate.
Over 6,000 Orange County residents
enrolled into the Marketplace for 2015
coverage (see figure 8).
Among the 38 states that used the
healthcare.gov platform, NC is the fourth
highest in total people who selected a
plan with more than 11.2 million people
(including all plan selections whether
they use state or federal marketplace).
66% of NC plan selections live at or under
200% Federal Poverty Level; 88% of
North Carolinians have received
subsidies.
*County level data was unavailable at time of report, Orange County’s
year three numbers is an estimate based on the statewide percent
350,000
559,473
613,487
4,732
6,978 7,675
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Year 1 (2014)Year 2 (2015)Year 3 (2016)
Or
a
n
g
e
C
o
u
n
t
y
E
n
r
o
l
l
m
e
n
t
No
r
t
h
C
a
r
o
l
i
n
a
E
n
r
o
l
l
m
e
n
t
Figure 8: County and State Affordable Care Act Year-
to-Year Enrollment
North Carolina Orange County
Figure 7:
13
Access to Dental Care
Oral health not only includes tooth and gum health, but other health conditions that may result from
poor oral health (gum disease contributes to heart disease; tobacco use contributes to tooth decay).
Issues in oral health include availability of affordable dental insurance, access to regular and preventive
care, and population specific issues like children’s dental heath, increasing refugee population needs,
and language barriers.
According to American Academy of Periodontology, people with periodontal (gum) disease have an
increased risk of heart disease and stroke19, while tooth decay is the most common childhood chronic
disease. Oral health begins with an individual taking responsibility for his/her behavior including oral
hygiene, home care practices, healthy diet and nutrition, avoidance of tobacco and alcohol, and periodic
preventive dental visits.
Orange County has a dentist rate of 9.9 per 100,000 people which is higher than NC (4.6) and the US
(6.0). However, the rate has decreased from a rate of 10.4 and 22% of survey respondents report
experiencing barriers to dental care (see figure 9).
The Orange County Health Department Dental Clinic, which is listed as Orange County’s oral health
safety net provider, is seeing a steady increase in the number of adult and pediatric patients treated
from 4,848 in 2014 to 5,280 in 2015.
In 2015, with the expansion of dental services, due to the successful increase in patients seen, the
Orange County Dental Clinic has expanded its services by increasing its physician number from 1 to
2.
Piedmont Health Services, Inc.’s full-scope family dentistry practice at its Carrboro Community
Health Center, another local safety net dental services provider, served 2,377 unduplicated
individuals (48% children, 52% adults) with 5,360 dental visits in 2015. In an effort to better meet
demand for care, the health center is currently planning a renovation to double the size of its dental
clinic from three to six chairs.
24%
22%
18%
9%
8%
4%
3%3%
3%2%2%
Figure 9: Places Respondents had Trouble Getting Medical Care
Specialist
Dentist
General Practitioner
Eye care/optometrist/ophthalmologist
Pharmacy/prescriptions
Hospital
Health Department
Medical Clinic
OB/GYN
Urgent Care Center
Pediatrition
14
Figure 10: Resident access to medical facilities
and bus stops in Orange County.
Access to Transportation
Transportation was cited in the 2007, 2011 and 2015
Orange County Community Health Assessments as a
barrier to accessing health care services, specifically for
northern Orange and rural residents. See figure 10 for
a map of those residents who live 1 mile within a
medical facility and bus stop.
3,000 individuals in Orange County with no vehicle
live outside of the walkable/ridable coverage area
to medical clinics (shown in the white region of
figure 10).
In 2014, there were 66,130 Orange County
residents, 16 years and over, commuting to work.
8% of that population (4,941) utilized public
transportation, 68% drove alone, 9% carpooled,
5% walked and 3% utilized other means20.
The disabled, elderly, and those on Medicaid
qualify for free or reduced cost transportation in
rural areas through Orange County Public
Transportation (OPT). Those who do not qualify
can request OPT pickup/drop-off for a one way
charge of $12.50.
OPT operates two midday/off peak fixed-route services
Monday through Friday, excluding County Holidays through the Hillsborough Circulator and the Orange-
Chapel Hill Midday Connector.
15
Figure 11: Where Survey Respondents Reported Getting
Most of their Health Related Information
Access to Health Information and Health Literacy
Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make appropriate health decisions21.
According to the Orange County Literacy Council, 12% (8,615) of Orange County residents have
literacy needs and most of these individuals live in the county’s unincorporated areas.
Almost half of Limited English
Proficiency (LEP) adults have nine
years or less of education, and 64%
do not have a high school degree22.
The majority of survey respondents,
regardless of income status, have
access to the internet (through a
computer, smart phone, or tablet),
whereas, only 1% of survey
respondents stated that they did not
have access to the internet (see
figure 11).
In response to 2011 health literacy concerns, Healthy Carolinians of Orange County, in conjunction with
the Orange County Board of Health hosted a health literacy training to educate providers on the
importance of being health literate when it comes to servicing patients. UNC Healthcare employee
trainers trained 46 participants in the areas of plain language, readability level when it comes to creating
and using materials, and the teach back method.
The Social Determinants of Health population health dashboard (located on page 16) provides county
level data on access to care as it relates to affordability and insurance, resources and prevention, and
health literacy.
16
Orange County, NC
2016 Population Health Dashboards
Summary:
Orange County generally has comparable rates of uninsured residents to North Carolina; however, low income
residents are twice as likely to be uninsured, as compared to the average county resident. And in 2013, a higher
percentage of low income youth under 19 were uninsured in Orange County [15% (+/- 3.2%)] as compared to North
Carolina [9.2% (+/- 0.7%)]. However, across all populations Orange County has seen a decrease in uninsured rates
from 2011 to 2013. In terms of resources, Orange County leads the state in physician density, and the supply of
physicians grew from 2012 to 2013 (+176, +13.6%). While Orange County ranks first in dentist density, the county
also showed the largest numerical decrease in the state in 2013 (-6, -4.2%).
Low Health Literacy is strongly tied with poorer health
outcomes and increased cost. It is mediated by age,
race, education and income.
Basic HL is rudimentary prose comprehension and
quantitative abilities, insufficient for many interactions
with health information. Below basic HL is extremely
low or non-existent comprehension.
Increase HL by (1) increasing patient skills and abilities
& (2) decreasing provider demand and complexity.
Health LiteracyHealth LiteracyHealth LiteracyHealth Literacy
Current
Basic prose illiteracy9%
Always understands doctor*84%
Always understands discharge*88%
Always understands medicine info*69%
*Consider biases. Best used in comparison w/ other HCAHPS elements.
Orange County
PeerNCUS
11%14%14%
- 83%81%
- 86%85%
- 65%64%
Compare to
Affordability and InsuranceAffordability and InsuranceAffordability and InsuranceAffordability and Insurance
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Uninsured (<65 years old)15.3%8.0%16.4%↓18.6%18.1%13.4%
% Low-income Uninsured (<65 years old, <200% FPL)31.8%NA 36.2%↓32.7%32.7%19.0%
% Children Uninsured (<19 years old)7.3%NA 9.0%↓6.5%6.9%6.0%
% Low Income Children Uninsured (<19 years old, <200% FPL)15.0%NA 20.0%↓9.2%9.2%8.0%
Resources and PreventionResources and PreventionResources and PreventionResources and Prevention
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Physicians Rate per 10,000 105.4 NA 93.6 ↑38.122.724.5
Primary Care Physician Rate per 10,000 24.9 NA 20.8 ↑14.68.67.6
Dentist Rate per 10,000 9.9 NA 10.4 ↓7.24.66.0
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Data Notes:
See the Public Health Dashboard FAQ Document for more on data methodology.
Sources: SAHIE, Sheps Center, Kaiser Family Foundation
Additional information from the 2014 Board of Health Access to Care Dashboard are re-printed below.
17
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to
Social Determinants of Health with specificity around Access and Poverty.
Agency /
Organization /
Initiative
Advocacy /
Community
Support
Affordable
Care Act
Support
Care
Coordination
Dental
Care
Financial
Assistance
Programs /
Support
Health /
Medical
Care
Health
Literacy
Immigrant
& Refugee
Support Pharmacy Transportation
Chapel Hill Transit X X
Carolina Health Net
(CHN) X X X X X X
El Centro Hispano X X
EZ Rider X X
Go Triangle X X
Healthy Carolinians
of Orange County X X
Immigrant and
Refugee Community
Partnership X X
Orange County
Department of
Social Services X X X
Orange County
Health Department X X X X X X X X
Orange County
Literacy Council X X
Orange County
Public
Transportation
(OPT) X X
Piedmont Health
Services X X X X X X
Planned
Parenthood X X X
Refugee Support
Center X X X X X X
The Family Success
Alliance X X X
UNC Center for
Latino Health X X X
UNC Family
Medicine X X X
UNC Healthcare
System X X X
Durham - Chapel
Hill - Carrboro
Metropolitan
Planning
Organization X X
Orange Unified
Transportation
Board X X
18
Mental Health & Substance Abuse
Mental Health
Mental Health refers to a wide range of conditions that affect one’s mood, thinking and behavior. Broad
classes of mental illness include mood disorders (depression, bipolar disorder), anxiety disorders,
psychotic disorders (schizophrenia), eating disorders, personality disorders, and addictive
behaviors/substance abuse disorders. Many factors contribute to mental health problems, including
genetics, biological factors, life experiences, and brain chemistry.
Mental and substance abuse disorders may be caused by a combination of factors which complicates
efforts to understand prevention best practices. Undiagnosed and untreated conditions can have
serious consequences leading to disrupted daily functioning, failure in school, unemployment, disability,
social isolation, family conflicts, addiction, or suicide.
As seen in figure 12, 12% of survey
respondents are unsure as to
where they would refer a friend or
family member who had a mental
health or substance abuse issue.
Nearly 10% of all Emergency
Department visits in NC list mental
illness as a diagnosis; 31% of
Emergency Department visits with
mental illness diagnosis resulted in
hospital admission23.
Subject matter experts express
that funding for mental health and substance abuse services has been cut repeatedly over the
years.
1 in 6 survey respondents listed mental health, including mental health issues (13%) and suicide
prevention (4%) as priority issues for needed for teens.
Suicide
Suicide is a serious public health problem that affects many people. In Orange County, suicide is the
second leading cause of death for individuals between the ages of 20 and 39 and is the fourth leading
cause of death for individuals between the ages of 40 and 64, with the highest prevalence being among
white males.
Over the past 5 years on record, Orange has had an average of 17 suicide deaths per year (up from
13 suicide deaths per year from 2003 to 2007). Orange County’s age-adjusted 5 year suicide rate is
10.4 suicides per 100,000 people, a decrease from 12.2 in 2013.
Suicides can be prevented by recognizing signs and symptoms, learning how to help, and taking steps to
provide help to people in need. Risk factors for suicide include, but are not limited to: previous suicide
Private
Counselor or
therapist
52%
Support group
9%
School Counselor
1%
Minister/religiou
s official
3%
Doctor
23%
Don't Know/Not
Sure
12%
Figure 12: Where survey respondents would refer a
friend who had a mental health or substance abuse
issue
19
attempts, history of depression or other mental illness, alcohol or drug abuse, family history of suicide
or violence, physical illness, and
feeling alone24.
51% of female and 39% of male
Orange County suicide victims
were characterized as being
currently depressed when they
completed suicide, as shown in
figure 13.
Among survey respondents 3 out
of 10 have been told by a doctor,
nurse, or other health
professional that they have had
depression or anxiety.
54% of female and 46% of male suicide victims
was characterized as having a current mental
health problem.
Females (23%) are more likely to attempt
suicide when compared to males (16%);
however, males are more likely to complete
suicide than females, as shown by figure 14.
1 out of 8 survey respondents stated that there
have been days in the past month when feeling
sad or worried have kept them from going
about their normal routine.
Substance Use/Abuse
Fewer adolescents in Orange County are using alcohol products or smoking cigarettes; however, there is
a marked increase in overall tobacco use among this group, primarily driven by the use of electronic
cigarettes and other novel tobacco products. Adult smoking appears to be stable, but alcohol use is
increasing.
Alcohol – Alcoholism is a medical disease that (1) involves periodic or constant impaired control over
drinking; (2) preoccupation with alcohol; (3) use and abuse of alcohol in spite of adverse consequences;
and (4) distorted thinking, especially denial. Alcoholism stems from genetic, environmental, and
psychosocial factors. Alcohol abuse is the intentional overuse of alcohol (to the point of drunkenness)
that includes occasional and celebratory over-drinking.
Overuse of alcohol is considered to be more than 3-4 drinks per occasion for women and more than
4-5 drinks per occasion for men.
Figure 13:
Figure 14:
20
Figure 15: Crashes that Involved
Alcohol, 2009-2013
One drink equals one (12-ounce) bottle of beer or wine cooler, one (5-ounce) glass of wine, or one
and a half ounces of liquor.25
High-risk drinking is often cited as the single biggest issue negatively impacting universities and their
communities. Orange County, especially the Town of Chapel Hill, is no exception.
According to survey data, 8% of
County adults drove after drinking
in the past 30 days, which is worse
than our peers (4%), NC (2%) and
the US (2%).
Based on data from Chapel Hill
Carrboro City Schools, 9% of High
Schoolers drove after drinking in
the past 30 days.
5.7% of Orange County motor
vehicle crashes are alcohol
related, (shown in figure 15) which is a higher rate than our peers (5%) and NC (4%)26.
Betel Nut – Betel Nut is the seed of an areca palm that is commonly chewed by immigrants and refugees
from South and Southeast Asia (e.g., Burma, Thailand, India, Bangladesh, Indonesia, Vietnam), parts of
East Africa, and the tropical Pacific.
Providers in Orange County noticed that some local refugees from Burma use Betel Nut and were
interested to learn more about the substance, which stains the teeth of the chewer. Prolonged use of
betel nut or betel quid can cause serious adverse health effects, including oral cancer and periodontal
disease. When used with tobacco, such as in the form of betel quid, the risk of cancer is greatly
increased and may also be harmful to pregnant women.
Poisonings – A poison is any substance that is harmful to your body when ingested (eaten), inhaled
(breathed), injected, or absorbed through the skin.
In Orange County approximately 17 people, of all ages, die per year due to poisoning, and
approximately 10 of those die from narcotic drug overdose.
Abuse of prescription painkillers now ranks second as the Nation’s most widespread illegal drug
problem.
In 2011, 1,140 NC residents died as a result of unintentional poisonings; approximately 80% of
those deaths were related to prescription drugs27.
21
Orange County has a drug
overdose mortality rate of 5.7,
which is lower than our peers
(9.7), NC (12.3) and the US (14.6).
As shown in figure 16, opiate
poisoning deaths (including
heroin, other opioids,
methadone, and /or other
synthetic opioids) account for an
average of 7 deaths per year.
Orange County’s prescription
opioid overdose mortality rate is 3.6 per 100,000 people, which is lower than NC (8.0) and the US
(5.3).
Tobacco – Tobacco use and secondhand smoke remain the leading causes of preventable illness and
death in both Orange County and NC.28 Tobacco refers to a range of products, such as cigarettes, cigars,
spit tobacco, hookah, and electronic cigarettes.
Smoking rates are 2-3 times higher among those with behavioral health issues and are consistently
higher among those with lower levels of income and educational attainment.29,30,31
Smoking accounts for at least 30% of all cancer deaths and 87% of all lung cancer deaths.32 Smoking
is also a major cause of heart disease, cerebrovascular disease, chronic bronchitis, emphysema, and
is associated with gastric ulcers.33
Smokeless tobacco contains 28 cancer-causing chemicals and can cause oral and pancreatic cancers,
tooth decay, and gum recession.34
Among survey respondents exposed to
secondhand smoke, majority reported
being exposed in public places (figure
17).
Secondhand smoke can cause heart
attacks and stroke and is especially
harmful to infants and children who can
experience asthma attacks, respiratory
infections, ear infections, and sudden
infant death syndrome (SIDS).35
About half of all children between ages 3 and 18 years are exposed to cigarette smoke regularly.36
7
4
11
6
10
6 6
10
5 5
0
5
10
15
2005200620072008200920102011201220132014
Figure 16: Orange County Opiate Poisoning Deaths,
2005-2014
Total Count Average
34%
24%
16%
11%
11%
3%1%
Figure 17: Locations Survey Respondents are
Exposed to Secondhand Smoke
Public Places
Home
Bars/Nightclubs
Restaurants
Work
Coffee Shops
Hospitals
22
While cigarette use is decreasing
among NC youth, overall tobacco
use is increasing, driven in large
part by use of e-cigarettes and
hookah (shown in figure 18).
Almost 4 out of 10 high school
students in Orange County have
tried an e-cigarette, and about 2
out of 10 high school students
currently use them.37
In 2014, more than two thirds of
middle and high school students were
exposed to e-cigarette ads in retail stores, on the Internet, in magazines or newspapers, and on TV or in
the movies.38 The tobacco industry spends almost $10 billion each year on advertising, which is more
than $1 million per hour.39
The research is still evolving on the public health implications of e-cigarettes and other vapor products.
The health risks from inhalation of nicotine, certain ingredients (such as flavors using diacetyls), and
some by-products have been established in the scientific literature.40,41 The nicotine poses dangers to
pregnant women and fetuses, children, and adolescents. Nicotine use among adolescents can actually
disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction.42
Research is sparse, however, on the acute and chronic impacts of inhaling common aerosol and vapor
components with as of yet unknown toxicity. Data suggest that e-cigarette use within a room could
cause secondhand exposures.43,44
The following Substance Abuse and Mental Health, and Tobacco and Respiratory population health
dashboards provides county level data specific to mental health and substance abuse. Data on
poisonings can be found on the Injury and Violence population health dashboard.
Unless we can dramatically reduce current
smoking rates, one out of 13 children alive
today will die a smoking-related death
- U. S. Surgeon General
Figure 18:
23
Orange County, NC
2016 Population Health Dashboards
Summary:
Behaviors associated with substance use show a decline in adolescent alcohol and cigarette use; however, indicators are needed at
the county level to examine trends in emerging tobacco products such as e-cigarettes. There currently is no local measure to
capture the use of these products by youth; however, North Carolina youth showed an uptick in tobacco use from 25.8% in 2011
to 29.7% in 2013, in part due to these emerging products. Adults show increases in these same behaviors. Indicators for the
prevalence of smokers have increased in particular. Alcohol related vehicle crashes make up a greater percentage of crashes in
Orange County than our peers or the state. Alzheimer’s disease Mortality and ED visits are increasing compared to previous years
and compared to our peers; however, Orange County performs better than the state on both of these indicators. While the
county performs better than benchmarks on mental health emergencies and mortality, 30% of Community Health Assessment
survey respondents reported having been told by a doctor, nurse or health professional that they have either depression or
anxiety. Access to mental health services is reported as a priority concern by residents and subject matter experts alike.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Data Notes:
*Due to changes in survey methodology and overlapping confidence intervals, BRFSS data cannot be compared to previous years
**Confidence intervals for YRBS trend data are unavailable to assess significance of trends over time
Rates are per 100,000 unless otherwise noted. See the Public Health Dashboard FAQ Document for more on data methodology.
AlcoholAlcoholAlcoholAlcohol
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Adults who Drink Excessively*22.8%24.4%20.7%-18.0%15.2%24.6%
% High schoolers using alcohol products (CHCCS)**32.0%26.0%35.0%↓35.0%34.0%38.0%
% Crashes that are Alcohol Related 5.7%4.7%5.8%SAME 4.5%4.2%9.0%
Illicit DrugsIllicit DrugsIllicit DrugsIllicit Drugs
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Illicit drug use self-report*9%7%7%-8%9%9%
% Providers registered in CSRS NA 22%NANA -53%27%NA
Drug Overdose Mortality Rate 5.7 NA 10.0 ↓9.712.314.6
Opioid Overdose Mortality Rate 3.6 NA 7.1 ↓4.48.05.3
Drug Overdose Crude ED Rate per 10,000 person-yrs14.5 NA 12.7 ↑16.621.0NA
TobaccoTobaccoTobaccoTobacco
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Adult Smokers*16.8%13.0%12.0%-17.0%20.9%21.0%
% High schoolers who smoked in past 30 days (CHCCS)**9.0%16.0%11.0%↓17.0%13.5%19.5%
Tobacco Use Disorder Crude ED Rate per 10,000 person-yrs95.3 NA 91.7 ↑404.1584.6 NA
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
Mental Health and EmergenciesMental Health and EmergenciesMental Health and EmergenciesMental Health and Emergencies
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Avg # Poor Mental Health Days / Month*2.52.82.9 ↓3.33.7 NA
Suicide Mortality Rate 10.48.312.2 ↓14.312.413.0
Mental Health Crude ED Rate per 10,000 person-yrs82.182.886.2 ↓94.3104.6 NA
Substance Abuse Crude ED Rate per 10,000 person-yrs 121.2 NA 121.8 SAME 136.2139.4 NA
ProgressOrange CountyTrendCompare to
Older Adult Mental HealthOlder Adult Mental HealthOlder Adult Mental HealthOlder Adult Mental Health
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Older Adults with Depression 15.0%NA 14.8%SAME 11.9%13.7%13.6%
Alzheimer's Age-Adj Mortality Rate 26.5 NA 27.4 SAME 15.829.226.8
Alzheimer's Crude ED Rate per 10,000 person-yrs10.6 NA 7.5 ↑6.916.6 NA
ProgressOrange CountyTrendCompare to
Sources: BRFSS, YRBS, DHHS/Highway Research Center, NC DETECT, CSRS
Data points are the most current measures from multiple sources (available on request).
24
Tobaccoaao Da
Orange County, NC
2016 Population Health Dashboards
Summary:
Smoking prevalence in Orange County is lower than peers, NC, and the US. However, indicators are needed at the
county level to examine trends in emerging tobacco products such as e-cigarettes. There currently is no local
measure to capture the use of these products by youth; however, North Carolina youth showed an uptick in tobacco
use from 25.8% in 2011 to 29.7% in 2013, in part due to these emerging products.
Exposure to secondhand smoke is higher than targets established by the Healthy NC 2020 objectives, but trending in a
positive direction. While Orange County rates for emergency department visits related to asthma are lower than
peers, NC, and the US, they have increased compared to previous years. Lung cancer mortality is better than all
benchmarks, but there is a higher rate of lung cancer in Orange County than the US as a whole.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend can not be assessed
Positive trend
Negative trend
Neutral trend
BehaviorsBehaviorsBehaviorsBehaviors
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Adult Smokers*16.8%13.0%12.0%-17.0%20.9%21.0%
% High schoolers who smoked in past 30 days (CHCCS)**9.0%16.0%11.0%↓17.0%13.5%19.5%
Tobacco Use Disorder Crude ED Rate per 10,000 person-yrs95.3 NA 91.7 ↑404.1584.6 NA
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
Asthma and Respiratory DiseaseAsthma and Respiratory DiseaseAsthma and Respiratory DiseaseAsthma and Respiratory Disease
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Asthma Current Diagnosis* 9.2%NA 11.6%-14.2%8.8%7.3%
Asthma Crude ED Rate per 10,000 person-yrs37.8 NA 36.8 SAME 60.793.869.7
Hospital Discharge Rate for Asthma 45.6 NANA -79.391.6143.0
Hospital Discharge Rate for Asthma, Age 0-1476.0 NANA -113.8148.9 NA
Chronic Lower Respiritory Disease Mortality 26.2 NA 28.4 ↓42.946.142.1
ProgressProgressProgressProgress Orange CountyOrange CountyOrange CountyOrange County TrendTrendTrendTrend Compare toCompare toCompare toCompare to
PoliciesPoliciesPoliciesPolicies
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Exposed to Secondhand Smoke at Work*6.4%0.0%8.0%-3.0%8.6%NA
ProgressProgressProgressProgress Orange CountyOrange CountyOrange CountyOrange County TrendTrendTrendTrend Compare toCompare toCompare toCompare to
Lung Cancer (Rate/100,000)Lung Cancer (Rate/100,000)Lung Cancer (Rate/100,000)Lung Cancer (Rate/100,000)
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Lung Cancer Incidence Rate 56.9 NA 59.1 ↓66.470.958.7
Lung Cancer Mortality Rate 43.945.542.1 ↑4650.647.2
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
Sources: BRFSS, YRBS, NC DETECT, NC SCHS
Data points are the most current measures from multiple sources (available on request).
Data Notes:
*Due to changes in survey methodology and overlapping confidence intervals, BRFSS data cannot be compared to previous years
**Confidence intervals for YRBS trend data are unavailable to assess significance of trends over time
Rates are per 100,000 unless otherwise noted. See the Public Health Dashboard FAQ Document for more on data methodology.
25
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to Mental Health and
Substance Abuse.
Agency / Organization /
Initiative
Advocacy /
Community
Support
Medical
Provider
Immigrant
& Refugee
Support
Mental
Health
Suicide
Prevention
Substance
Abuse
Prevention
Cardinal Innovations X X X X
Drug Treatment Court X X
El Futuro X X X X
Faith Connections on Mental Health X X
Freedom House Recovery Center X X X X
Healthy Carolinians of Orange
County X X X X
Mental Health America of the
Triangle X X X
National Suicide Prevention Hotline X X
Orange County Department of
Social Services X
Orange County Health Department X X X X
Orange County National Alliance on
Mental Illness (NAMI) X X
Orange County Town/Gown
Collaborative X
Orange Partnership for Alcohol and
Drug Free Youth X X
UNC Center for Excellence in
Community Health X X
UNC Family Medicine X X X
UNC Healthcare's Alcohol and
Substance Abuse Treatment
Program (ASAP) X X X
26
Physical Activity, Nutrition & Healthy Weight
Physical Activity & Nutrition
Orange County has shown improvements in
residents with a healthy weight. However, the
percentage of adults meeting recommendations for
exercise and fruit and vegetable consumption lags
behind our peers.
According to national surveys, adults show
negative trends in both physical activity and
nutrition. Adults should receive at least 150
minutes of moderate-intense physical activity
(PA) per week. Children and adolescents are
recommended to receive one hour of PA daily.
43.2% of adults did not meet aerobic nor
strengthening guidelines.
78% of Orange County high schoolers do not get
60 minutes of exercise/day.
Future Public Health interventions should note that 5% of survey respondents feel that exercising is too
expensive and that there are no safe places to exercise, as shown in figure 19.
The amount of fruit you need to consume depends on age, sex, and level of physical activity with the
average being between 1 and 2 cups per day. For instance, children 2 -8 years should consume 1 to 1 ½
cups; girls 9-18 years should consume 1 ½ cups; boys 9-18 years should consume 1 ½ - 2 cups; women
19 and over should consume 1 ½ - 2 cups and men 19 and over should consume 2 cups.45.
Student fruit and vegetable consumption is improving compared to previous years; however,
Orange County still performs worse than the US.
45% of high schoolers do not eat one or more servings of fruits and vegetables a day. National
recommendations far exceed one serving each of fruits and vegetables per day, meaning many more
students likely still do not meet national recommendations.
75.4% of Orange County adults do not eat 5+ fruits or veggies per day.
28%
24%15%
8%
8%
6%
4%3%
3%
1%
Figure 19: Reasons why survey respondents
don't exercise
I don't have time
I'm too tired to exercise
I don't like to exercise
I have no one to exercise
with
I don’t have convenient
exercise facilities
I'm physically disabled
It costs too much
my job is physical or hard
labor
Exercise is not important to
me
There is no safe place to
exercise
27
Healthy Weight
1 in 5 adults are obese.
1 in 2 adults are a healthy weight.
14% of low-income preschool children are
obese.
According to survey results 47% of survey
respondents would be considered overweight
or obese based on their Body Mass Index
(BMI), however, only 30% of survey
respondents (shown in figure 20) reported
having been told by a doctor that they are
overweight or obese.
Nutrition in our Schools
The number and percent of students on free or reduced lunch has increased, both countywide and
in both school districts.
34% of children in Orange County’s two districts receive free or reduced lunch, an increase from the
32% (6,177 students) in 2011-2012.
According to Subject Matter experts:
o School Nutrition in the last 4 years has changed dramatically in respect to Healthy, Hunger-Free
Kids Act of 2010 and the Let's Move Campaign.
o Both school districts in Orange County have seen improvements in school nutrition policies
including one district’s requirement of fruits/veggies at breakfast and lunch; whole grain in
breads and baked goods; and low fat and nonfat dairy products, and another districts’ policy to
cut out any food outside of the school food service program.
The following Physical Activity and Nutrition population health dashboard provides county level data
specific to physical activity, nutrition and healthy weight.
Table 5: Students receiving free or reduced lunch
Student Nutrition Orange County
Percent of students in free and reduced
school meal program.
34% (6,631)
Percent of children in free and reduced
meal program actually getting free and
reduced price school meals.
14% (901)
Underweight
3%
Normal
51%
Overweight
29%
Obese
17%
Figure 20: BMI among survey respondents
28
Orange County, NC
2016 Population Health Dashboards
Summary:
Orange County has shown some improvements in residents with a healthy weight according to national surveys.
However, according to Community Health Assessment (CHA) results, 47% of survey respondents would be considered
overweight or obese based on their BMI. In contrast, only 30% of survey respondents reported having been told by a
doctor that they are overweight or obese. Sixty-five percent of CHA survey respondents reported meeting exercise
recommendations, though the population who responded to the online portion of the survey were not randomly
sampled. Adults show negative trends in both physical activity and healthy nutrition according to national surveys.
Student fruit and vegetable consumption is improving compared to previous years; however, Orange County still
performs worse than the US. In addition, national recommendations far exceed one serving each of fruits and
vegetables per day, meaning many more students likely still do not meet national recommendations.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Physical Activity, Nutrition, and WeightPhysical Activity, Nutrition, and WeightPhysical Activity, Nutrition, and WeightPhysical Activity, Nutrition, and Weight
IconCurrentTargetPreviousProgressPeerNCUS
% Adults Getting Recommended Exercise*51.7%60.6%44.5%-52.7%46.7%51.7%
% High Schoolers getting 60 min exercise/day (CHCCS)**22.0%50.0%NA -NA 25.9%27.1%
% Adults Eating 5+ Fruits or Veggies/Day*24.6%29.3%31.1%-17.0%13.7%NA
% High Schoolers eating Fruits and Veggies 1+/Day**55.0%NA 53.0%↑NANA 62.0%
% Adults with Healthy Weight*49.2%33.9%46.2%-51.8%33.3%29.5%
% High Schoolers not overweight or obese (CHCCS)**78.0%79.2%77.0%SAME NA 71.4%69.7%
% Low-income Preschool Children Obese14.1%NA 17.4%↓14.1%13.6%12.2%
% Population that is Food Insecure 14.0%6.0%NA -16.0%17.3%14.5%
% Kids in Food Insecure Households 20.7%NANA -23.7%25.0%19.9%
Progress Orange County Trend Compare to
Sources: BRFSS, YRBS, PedNSS, UNC School of Government Hunger Research
Data points are the most current measures from multiple sources (available on request).
Data Notes:
*Due to changes in survey methodology and overlapping confidence intervals, BRFSS data cannot be compared to previous years
**Confidence intervals for YRBS trend data are unavailable to assess significance of trends over time
Rates are per 100,000 unless otherwise noted. See the Public Health Dashboard FAQ Document for more on data methodology.
29
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to Physical Activity
and Nutrition.
Agency / Organization / Initiative
Advocacy /
Community
Support
Education Fitness
Nutrition
Services /
Support
School
Nutrition Swimming
Carolina Health Net (CHN) X X
Chapel Hill - Carrboro City School X X X X
Chapel Hill - Carrboro YMCA X X X X
Chapel Hill Parks & Recreation X X X X
Department of Environment,
Agriculture, Parks and Recreation
(DEAPR) X X X X
Eat Smart Move More North Carolina X X X X
Healthy Carolinians of Orange
County X X
Mebane Recreation and Parks
Department X X
Orange County Cooperative
Extension X X X
Orange County Department on Aging X X X
Orange County Health Department X X
Orange county partnership for young
children X X X X
Orange County Schools X X X X
UNC Healthcare X X X
UNC Wellness Center X X X X X
30
eading Causes o eath and isease
Orange County’s top priority health issues predominantly encompass social determinants of health and
health behaviors. These are actionable areas for public health intervention geared towards preventing
death and disease. The top leading causes of death in Orange County are shown in figure 21.
eading Causes o eaths
Figure 21: eading Causes o eath, 2010 – 2014, Ag e-Adjusted Mortality Rates per 100,00046
The top leading causes of death vary by age group and table 6 lists the top 3 leading causes of death for
each age group47.
Table 6: eading Causes o eath by age group
Age Group Rank Cause o eath # o eaths eath Rate
All Ages 1 All Cancers 947 158.6
2 Heart Disease 676 118.4
3 Cerebrovascular 188 34.1
# o eaths eath Rate
0-19 1 Perinatal 15 8.2
2 Motor Vehicle 9 4.9
3 Birth Defects 7 3.8
# o eaths eath Rate
20-39 1 Unintentional Injuries 22 10.4
2 Suicide 21 9.9
3 All Cancers 17 8
# o eaths eath Rate
40-64 1 All Cancers 280 127.3
2 Diseases of the Heart 143 65
3 Unintentional Injuries 45 20.5
# o eaths eath Rate
65-84 1 All Cancers 482 767.6
2 Diseases of the Heart 275 437.9
3 Chronic Lower Respiratory Diseases 82 130.6
# o eaths eath Rate
85+ 1 Diseases of the Heart 248 2872.4
2 All Cancers 162 1876.3
3 Alzheimer's Disease 107 1239.3
158.6
118.4
34.1
27.7
26.5
24.4
13.7
13
12.1
10.4
050100150200250
Cancer
Stroke
Alzheimer's Disease
Pneumonia and influenza
Septicemis
Rate
Count
31
Chronic isease
Chronic disease refers to diseases that are long-lasting in nature (including cancer, type II diabetes, heart
disease, and stroke) and is one of the biggest causes of poor health. Although genetics and other factors
contribute to the development of chronic health conditions, individual behaviors play a major role.
In 2013, nearly 50 million dollars was spent on cardiovascular and circulatory disease inpatient visits
in Orange County.
Figure 22 shows the percent of survey respondents who have been told by a health care provider
that they have a chronic disease.
Cancer
While there hasn’t been a change in the overall cancer rate, Orange County has seen increases in
prostate cancer, colorectal cancer, and female breast cancer. According to the National Cancer
Institute, it is estimated that nearly 80% of cancers are due to factors that can potentially be controlled
to reduce cancer risk. Controllable factors that contribute to the development of cancer include tobacco
and alcohol use, poor nutrition, unhealthy weight, physical inactivity, and exposure to radiation.
52% of all deaths in Orange County are caused by cancer, diseases of the heart, or chronic
respiratory diseases.
Orange County has a lower age-adjusted cancer
death rate than NC averages in all categories
except for breast cancer (22.1 vs. 21.7 per
100,000 people)48.
Cancer remains the top cause of death in the
County. Trachea, bronchus, and lung cancers are
the most common in both men and women.
In 2012, 536 cancer cases were reported for
Orange County residents.
In 2013 Orange County had a cancer death rate of
27.7%, compared to 22.3% in NC with a
breakdown shown in figure 23.
5%
26%25%
6%6%
12%
16%
Heart DiseaseHigh blood
pressure
High
cholesterol
DiabetesOsteoporosisCancerAsthma
Figure 22: I have been told by a doctor that I have.....
Figure 23:
32
Controllable Factor – Health Screenings
Screenings refers to testing to find chronic diseases in individuals who do not experience symptoms. In
men, prostate cancer can often be found early by testing the amount of Prostate-Specific Antigen (PSA)
in a man’s blood or through a Digital Rectal Exam (DRE).
79% of men survey respondents over 45 years of age reported having had a PSA test or a DRE.
Majority of survey respondents, both men and women, report having had a mammograms and/or
blood stool tests as a preventative health measure towards cancer, as shown in figure 24.
Stroke
Cerebrovascular disease (often resulting in stroke) is the disease that affects the arteries (vessels that
carry blood away from the heart) of the brain. A stroke occurs when blood can’t get to the brain
because the vessels burst or are clogged49.
NC is part of the “Stroke Belt” - an 11-state region of the US where studies show that the risk of stroke is
34% higher for the general population than it is in other areas of the country. Other states include
Mississippi, Tennessee, Louisiana, Kentucky, Georgia, Alabama, South Carolina, Arkansas, Indiana and
Virginia50.
Orange County has seen a constant
decline in stroke deaths, as seen in
figure 25.
69.8
44.9
32.9
72.2
54
43.7
0
10
20
30
40
50
60
70
80
1999-20032004-20082009-2013
Figure 25: Age-Adjusted Stroke Death Rates per
100,000 Residents
Orange County
North Carolina
0%
20%
40%
60%
80%
100%
120%
Women over 40 who
received a
Mammogram
All over 50 who
received a Blood Stool
Test
Figure 24: Survey respondents self reported health
screenings
Total Respondents
Respodents below
200% FPL
Respondents over
200% FPL
33
132.3
123.2 118.4
87 91.9 94.7
0
50
100
150
201220132014
Figure 26: Heart Disease Mortality Rates per
100,000 People
3-year Age-
Adjusted
Death Rate
1-year
Crude
Death Rate
Heart Disease
Heart disease is a term that describes several conditions that affect the heart and cardiovascular system.
Types of heart disease include: coronary heart disease (the most common and the leading cause of heart
attacks), heart failure, and heart arrhythmias (changes in the heart beat)51.
In Orange County, the age-adjusted mortality rate for heart disease has declined in recent years
(shown in figure 26) however, the crude mortality rate is increasing due to the county’s aging
population (shown in table 7).
5% of survey respondents reported having been diagnosed with heart disease.
Diabetes
Diabetes is a group of diseases marked by high levels of blood glucose, resulting from defects in insulin
production, insulin action, or both. When food containing carbohydrates is consumed, the body breaks
down this food into glucose (sugar), which is the basic fuel for the body. Insulin is the body’s hormone
that helps glucose get into the cells to be used for energy. In Type 1 diabetes, the body does not make
insulin; and in the more common Type 2 diabetes, the body does not make or use insulin properly
causing blood glucose to rise, leading to extensive damage to the body over time52.
Orange County’s 2010-2014 age-adjusted death rate for Diabetes Mellitus is 13.0, compared to 11.4
from 2009-2013, and NC has a rate of 22.1 per 100,000 people (shown in figure 27).
Table 7: Orange County Heart Disease
Deaths from 2013 - 2014
Year
Number of Heart Disease
Deaths
2012 120
2013 129
2014 133
17.8 17.6
11.4
27.7 24.7
21.7
0
5
10
15
20
25
30
1999-20032004-20082009-2013
Figure 27: Age-Adjusted Diabetes Death Rates per
100,000 People
Orange County
North Carolina
34
Communicable Diseases
Communicable Disease
Communicable diseases spread from one person to another or from animal to person. The spread often
happens via airborne viruses or bacteria, but also through blood or other bodily fluid. The terms
infectious and contagious are often used interchangeably to describe communicable disease53. Table 8
lists the reported communicable diseases and conditions from 2011 – 2014 among Orange County
residents.
Table 8: Reported Communicable Diseases and Conditions in Orange County by Year
Number of Cases
Disease/Condition 2011 2012 2013 2014
Campylobacter 18 31 25 21
CJD 1 0 0 0
Cryptosporidium 1 3 8 7
Dengue 1 0 0 0
E.coli (Shiga-toxin producing) 4 2 4 5
Ehrlichiosos 6 4 4 4
Encephalitis (arboviral) 0 0 0 2
Group A Strep (invasive) 2 1 5 5
Haemophilus influenza, invasive 0 0 1 2
Hemolytic Uremic Syndrome 0 0 1 0
Hepatitis A 0 1 1 0
Hepatitis B (Acute) 3 0 0 0
Hepatitis B (Chronic)* 32 24 17 12
Hepatitis B (Perinatal) 2 12 1 10
Influenza Death** 1 0 0 0
Legionellosis 0 0 1 2
Lyme 8 3 3 5
Malaria 0 2 1 3
Measles 0 0 8 0
Meningococcal Disease 1 0 0 1
Pertussis 4 23 4 10
Q Fever 0 0 0 1
Rocky Mtn. Spotted Fever 8 24 16 19
Rabies (Animal) 12 13 13 22
Possible Rabies Contacts 301 333 418 523
Salmonellosis 26 21 21 27
Shigellosis 0 0 4 1
TB 3 2 3 1
Toxic Shock Syndrome 1 0 1 0
Tularemia 0 1 0 0
Vibrio 1 0 1 0
35
Influenza (flu) and pneumonia
The flu is a contagious respiratory illness caused by flu viruses. Adults age 65+ are at a greater risk of
pneumonia and flu than the rest of the population, as are those with chronic lung disease, heart disease,
and compromised immune systems. Health care workers and residents of nursing homes and long-term
care facilities are also at greater risk. Seasonal flu vaccines change annually as the virus naturally
changes over time. Flu season runs from September to March, with the number of cases peaking in
January or February.
There were 218 flu deaths reported in NC during the 2014-2015 flu season, with 0 deaths reported
among Orange County residents.
Vaccine Preventable Diseases
Vaccine-preventable diseases are diseases that can usually be prevented by obtaining required or
recommended vaccinations prior to exposure to the illness. Vaccinations are widely recognized as one
of the most important public health strategies ever employed. New immigrants are seen to be at
greater risks of vaccine-preventable diseases, specifically if they have not received vaccinations in their
home countries.
Children who have not been appropriately vaccinated are at risk of serious diseases. Vaccines required
by North Carolina Immunization Law for daycare and school entry provide protection against the 10
diseases of:
Diphtheria
Tetanus
Pertussis (whooping cough)
Polio
Measles, mumps, rubella
Haemophilus
Influenza
Type B (Hib)
Hepatitis B, and
Varicella (chicken pox)
Sexually Transmitted Diseases
Sexually transmitted diseases (STD’s) including human immunodeficiency virus (HIV) falls strangely on
disadvantaged populations, young people, and minorities and affects tens of thousands of North
Carolinians every year. These preventable conditions can lead to reduced quality of life as well as
premature death and disability. Table 9 shows the (preliminary) cases of STD’s among Orange County
residents over the past 3 years.
Table 9: Sexually Transmitted Disease Cases among Orange County residents by year 2013-201554
2013 2014 2015
Gonorrhea cases 114 112 183
Chlamydia cases 470 472 684
Syphilis cases 3 17 13
Newly reported HIV infections among
OC residents
16 14 12
Newly reported AIDS cases among OC
residents
8 10 8
*The above numbers are preliminary and were obtained from the 2015 fourth quarter report, annual numbers were not available.
36
Figure 28:
Although Orange County data was not available, NC statistics on new HIV cases in 2014 are below55,
(also expressed in figure 28):
Nearly 40% were among young men (aged 13 to 29).
Nearly 50% were among women over the age of 40.
64% were among men who report sex with men (MSM).
36% were among women who were exposed through heterosexual contact.
22% of men were diagnosed with AIDS within 6 months of their HIV diagnosis.
19% of women were diagnosed with AIDS within 6 months of their HIV diagnosis.
Almost two-thirds of all new HIV infections are among Blacks.
37
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to death and disease.
Agency /
Organization /
Initiative
Advocacy /
Community
Support Education
Diabetes
Mgmt.
Cancer
Prevention
/ Support
Cardiac
Rehab
Chronic
Disease
Prevention
Communicable
/ Infectious
Disease
Nutrition
Services /
Support
Sexually
Transmitted
Diseases
American
Heart
Association of
Eastern North
Carolina X X X
Carolina Well X X X X
Orange County
Health
Department X X X X X X
Piedmont
Health
Services X X X X X X X
Planned
Parenthood -
Chapel Hill
Health Center X X X
UNC Cardiac
Rehab X X X X
UNC
Comprehensiv
e Cancer
Support
Program X X X X
UNC Health
Care X
UNC Wellness
Center X X X X X
38
Bachelor’s
Degree or
Higher
58%
High
School or
Some
College
34%
Less Than
High
School
8%
Figure 29: Education Attainment
Social Determinants of Health
Social Determinants of Health includes the availability of health care services; affordability of services
and health insurance; ability to navigate and understand the health system; physical access to services
(including transportation and disability access); information about health care, human-made structures
and community design (such as housing, recreational facilities, sidewalks, streets, businesses, schools,
parks, playground); and socioeconomic conditions to include poverty and homelessness. Poverty,
education level, and housing are three important social determinants of health.
Education
Figure 29 shows that 34% of Orange County’s
residents have at least a high school diploma,
while over half have a bachelor’s degree or a
form of higher education.
According to Orange County’s Community
Profile, Chapel Hill Carrboro City Schools
(CHCCS) serves more than 11,000 students
through three traditional high schools, four
middle schools, ten elementary schools, a
school for young people who are patients at
UNC Hospital, and an alternative school.
Orange County Schools serves more than 7,000 students with seven elementary schools, three middle
schools and two high schools, one of which (Cedar Ridge) offers an International Baccalaureate Diploma.
The CHCCS district has the highest average SAT scores (shown in table 10) in the state and its high
schools have been sighted in Newsweek magazine’s list of top high schools56.
Table 10: 2015 Average SAT Scores
Chapel Hill-Carrboro Schools 1776
Orange County Schools 1539
North Carolina 1478
United States 1490
Racial Equity
Racial equity is the condition that would be achieved if one’s racial identity is no longer predicted, in a
statistical sense, how one fares.
Though CHCCS district is often applauded for its high scores and graduation rates, these figures obscure
the reality of racial inequity, a reality that for most African American and Latino students means a
substantial and persistent gap between educational goals and results. The mission of CHCCS is “to
ensure that all students acquire the knowledge, skills, behaviors, and attitudes to achieve their learning
potential.”
39
Figure 30
Within CHCCS:
In 2014 – 2015, across all end of grade and end of course test results, 42% of African American
students and 47% of Latino students achieved the bare minimum performance of grade level
proficiency, compared to 90% proficiency of white students, shown in figure 30.
Across all grades from 2013 to 2015, only 25% - 35% of students of color were considered on track
to be college/career ready.
In 2013 – 2014 school year, African Americans students were sent to the office 3 times more
frequently than their white peers, and were suspended 8 times more often.
White students and students of color are disciplined differently for the same infractions.
In Chapel Hill-Carrboro City Schools access of African American and Latino students to gifted
programming is limited. As of 2012 - 2013, African American and Latino students represented 12%-
14% of students but only 5% of students participating in gifted programming57.
To assist with the concerns of racial equity, CHCCS is one of only 3 school districts in NC to fund a
full-time Director of Equity.
40
Figure 31:
Figure 32:
Injury and Violence
Injury and violence is the main cause of death and disability for people under age 44 and may be
unintentional like those resulting from motor vehicle crashes, falls, burns, poisonings, drowning, etc.; or
violent and intentional including sexual assault, child abuse, partner violence, suicide, and homicide.
Additional information on suicides can be found under Mental Health and Substance Abuse.
During the years of 2004-2013, there
were 204 violent injury deaths sustained
in Orange County. Of these 204 deaths,
200 were NC residents (98%) and 172
were Orange County residents (84%).
From 2004-2013, (as shown in figure 31)
Orange County experienced 145 suicides
(71%), 47 homicides (23%), zero
unintentional firearm deaths (0%), 1
death from legal interventions (<1%), and
11 deaths of undetermined intent (5%).
The violent crime rate in Orange County is
151.1, which is higher than our peers
(143.7) but lower than NC (333.0) and the
US (365.5).
Orange County has an assault rate of 95.7 and a rape rate of 15.6 per 100,000 people.
1 in 5 deaths for residents under the age of 19 are due to a motor vehicle injury.
In contrast, blacks had 11.9 homicides per 100,000 people as opposed to whites who had 2.5
homicides per 100,000 people. All other racial groups combined had 1 homicide, shown in figure 32.
79% of County homicides and 42% of suicides were committed using firearms.
Suspicion of intoxication was reported in
23% of homicides and 35% of suicides.
In Orange County, the suicide ratio was 3.1
times higher in males than females, and
the homicide ratio was 3.7 times higher in
males than in females.
Suicides and homicides displayed
dissimilar age patterns. Homicides peaked
among those 45 to 54 with 7.2 homicides
per 100,000 people. Suicides (19.1 per
100,000 people) peaked among those 25
to 34 years old.
41
Chapel Hill
Hillsborough
Figure 33: Population with Limited Food
Access, Low Income, Percent by Tract
Food Insecurity and Financial Assistance
Food security is defined as access by all people at all times to have enough food for an active, healthy
life. At minimum, this includes the availability of nutritionally adequate and safe foods in geographic
proximity. The USDA uses one mile in an urban area and ten miles in a rural area as the threshold
measure. That is, if a physical location in an urban setting is further than 1 mile from a grocery store,
that location is considered to be in a food desert58. Subject matter experts have expanded this definition
to include economically accessible food as well as encouraged consideration of other barriers to food
access such as transportation.
21% of children and 15.4% of the overall
population (20,900 people) live in food
insecure households in Orange County.
Figure 33 shows residents experiencing the
highest levels of food insecurity (over 50%)
reside in the southern part of the county.
26% of children in North Carolina live in
food insecure households.
In our neighboring (Durham) county, 20% of
children and 18% of the overall population
are food insecure59.
NC ranked among the top ten states, from
2010 - 2015, with the highest percent of
citizens experiencing food shortages.
28% of food pantries in NC turn clients
away for lack of food.
While community residents feel that food insecurity is an issue, especially within our low income
areas, survey respondents who are low income were nearly 10 times as likely to have cut the size of
meals or skipped meals in the past 30 days compared to those of higher income.
There are approximately 160 - 170,000 different people in NC receiving emergency food assistance
in a given week. Many of these families are forced to choose between heating their homes, paying
for housing and purchasing food for families.
The number of families receiving food stamps has almost doubled over the past five years.
The Food and Nutrition Services Program (formerly Food Stamps) is a federal program that provides a
monthly allotment of benefits issued via Electronic Benefit Transfer cards (EBT cards) that can be used
to purchase most foods at participating stores.
42
Eligibility to qualify for the Food and Nutrition Services Program is determined by:
Income
Household composition
Citizenship/Immigration Status, and
Resources.
The Supplemental Nutrition Assistance Program (SNAP) helps to alleviate hunger by supplementing food
budgets in low-income households. SNAP is used by children, working parents, elderly, and people with
disabilities.
8.2% of county residents utilized SNAP/EBT benefits over the past 12 months, accounting for
approximately 4,213 persons60.
AffordableHousing
Housing that is priced so that households with low incomes can afford to purchase and very low
incomes can afford to rent it is considered affordable housing. Low income households should not pay
more than 30% of their income for the rent and utilities or mortgage.
Half of Orange County households (52.7%) who rent spend more than 30% of their income on rent.
Hourly and income wages, for Orange County, are higher than NC when it comes to affording a 2-
bedroom apartment (shown in table 11).
1 in 5 households, in Orange County, experience overcrowding, high housing costs or a lack of
kitchen or plumbing facilities.
Orange County’s median gross rent is $918, compared to NC ($790) and the US ($920).61
60.5% of county residents own their homes, compared to 66.4% in NC62.
Table11:IncomeandHourlyWageNeededtoAfforda 2BedroomApartment,2014
IncomeNeededtoAfforda2 -
BedroomApartment
Hourly WageNeededtoAfforda2 -
BedroomApartment
Orange County $33,720 $16.21
North Carolina $29,897 $14.37
43
Homelessness
Directly related to housing is the problem of homelessness. According to US Department of Housing and
Urban Development (HUD), a person is considered homeless if they reside in 1) a place not meant for
human habitation such as a car, street, or abandoned building; or 2) an emergency shelter, transitional
housing or supportive housing for homeless persons who originally came from the streets.
Orange County represents 0.08% of North Carolina’s total homeless population (shown in figure 34).
24% of Orange County’s homeless population is made up of families (including children and adults)
compared to 35% of families in NC (shown in table 12).
Homeless single men in Orange County (58%) exceed single men in NC (47%), while homeless single
women in Orange County (18%) slightly exceed single women in NC (17%).
12% of the homeless persons in the Orange County are veterans, compared to 10% in NC, and 17%
in Durham County (which is the second highest veteran proportion in the state).63
Table 12 : Orange County Homeless persons by Family
Structure
Total Homeless 108
Families with Children 24%
Children 16%
Adults 8%
Children in Child-Only Families 0%
Adults, no Dependent Children 76%
Men 58%
Women 18%
Figure 34:
44
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to Social
Determinants of Health.
Agency / Organization /
Initiative
Advocacy
/
Communi
ty
Support Education
Financial
Assistance
Programs /
Support
Food
Access
Homeless
ness
Housing
Assistanc
e /
Shelters
Injury
&
Violen
ce
Preven
tion
Immigr
ant &
Refuge
e
Suppor
t
Legal /
Career
Couns
eling
Racial
Equit
y
Senior
Assistanc
e
Parentin
g
Anathoth Farm & Garden X X
Carrboro Farmers Market X X X
Carrboro Police Department X X
Chapel Hill - Carrboro City
Schools X X X X X
Chapel Hill - Carrboro
NAACP X X X X X
Chapel Hill Farmers Market X X
Chapel Hill Police
Department X X
Compass Center X X X X X
Eno Rivers Farmers Market X X
Habitat for Humanity X X X X
Hillsborough Farmers
Market X X
Hillsborough Police
Department X X
Housing for New Hope X X X X
Housing, Human Rights and
Community Development X X
Immigrant & Refugee
Community Partnership X X X X X
Inter Faith Council X X X X
Orange Congregations in
Mission X X X
Orange County Cooperative
Extension X X X
Orange County Department
of Social Services X X X X X X X X X X
Orange County Department
on Aging X X X X
Orange County Food
Council X X
Orange County Partnership
to End Homelessness X X
Orange County Rape Crisis
Center X X
Orange County Schools X X
Orange County Sheriff
Department X X
Organizing Against Racism
(OAR) X X
Refugee Support Center X X X X X X
Southern Village Farmers
Market X X
Transplanting Traditions
Community Farm X X X
UNC Center for Health
Promotion and Disease
Prevention X X X X
45
Figure 35:
aternal and Infant Health
Teenage Pregnancy
Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of
conception. Unintended pregnancy is among the most troubling public health problems and a major
reproductive health issue including accidental pregnancy and defined as a pregnancy that was undesired
for one or both of the partners64.
In 2013, NC reported a record low for the sixth
consecutive year. Of the 75 counties with reportable
rates, Orange County has the lowest with 9.6 per 1,000
people, which was a total of 68 pregnancies in 2013.
Orange County’s teen pregnancy rate dropped 35%
from 2012. The rate moved from 14.8 pregnancies per
1,000 15 to 19-year-old women to 9.6 per 1,000 in
2013 (shown in figure 35). This number represents a
total of 102 teen pregnancies in 2012 down to 68 in
2013.
Orange County has historically had one of the lowest rates
in the state, but this large reduction year-to-year is notable
and a positive step.
Even with this lowest and dropping overall rate, rate disparities exist by race and ethnicity similarly to
many other counties. While rates among white, black, and Hispanic teens have continued to drop, the
pregnancy rates among black and Hispanic teens are significantly higher than the rates of white teens on
average from 2010 to 2013 (shown in table 13).
Table 13: Teen Pregnancies within Orange County and NC, 2014 Orange County North Carolina
Number of pregnancies among 15-19-year-old girls: 69 10,328
Teen pregnancy rate per 1,000 15-19-year-old girls: 9.6 32.3
Teen Pregnancy rates by race/ethnicity
Black: 31.9 44.0
Hispanic * 52.8
White 4.3 23.1
Teen pregnancy rates by age
15-17 year olds 9.1 15.5
18-19 year olds 9.8 56.5
Number of pregnancies among 15-17-year-old girls: 23 2,909
Number of pregnancies among 18-19-year-old girls: 46 7,419
Percent of Repeat Pregnancies: 8.7% 22.4%
Teen birth rate per 1,000 15-19-year-old girls: 4.4 25.9
Change since 2013: -0% -8.5%
*Rates based on small numbers (<20 pregnancies) are unstable and not provided.
46
Infant Mortality
Infant mortality refers to the death of a baby in its first year of life. Risk factors that attribute to infant
deaths include premature or low birth weight, smoking during pregnancy, exposure to secondhand
smoke during pregnancy, and inadequate nutrition and insufficient intake of folic acid (a vitamin B)
before and during pregnancy.
In 2014 Orange County
experienced 6 total infant deaths,
an increase from 2013 where we
experienced 4.
Of those six deaths, 3 were white,
2 were African American, and 1
was Hispanic (shown in figure36).
Infant mortality racial disparity
ratio between African Americans
and whites, in Orange County, is
3.76 which is currently higher
than both NC (2.39) and the US
(2.21).
The county’s infant mortality rates are unstable due to the numbers being smaller than 10. Although
they are overall lower than NC’s rates, we still see a concerning disparity along racial and ethnic lines65.
Children born to mothers who smoke during pregnancy have an increased risk of Sudden Infant
Death Syndrome (SIDS) by 20-30%66, increased risk of birth defects including cleft palate or cleft
lip,67 heart defects,68impaired neurological and intellectual development, long-term negative
impacts on language and cognitive development69, lower scores on math and spelling achievement
tests,70 risk for mental retardation71 and lower levels of "good" HDL cholesterol, which may increase
their risk of heart attack and stroke later in life.72
Infant Health
Preventive health services are available to children from birth to 21 years of age. A child’s vision, speech,
hearing, and development can be screened, they can be checked for anemia, lead poisoning and chronic
diseases, and they can receive dietary counseling, which are provided through well child and pediatric
primary care clinics.
The robust system of lactation support throughout the county results in a breastfeeding rate among
WIC clients, exclusively breastfeeding, (41.6%) that is 12% higher than the NC average (29.1%) and
17% higher than the average for southeastern US (24%).
Two of the county’s three municipalities are working to become “Breastfeeding Family Friendly
Cities” by World Breastfeeding Week, 2016. This newly minted designation, developed by the
Carolina Global Breastfeeding Institute includes community-wide policy and environmental changes
to support breastfeeding.
4.9 4.2
10.9
0.0
5.6
0.0
7.1
5.1
12.8
9.4
6.2
4.0
Total RateWhite RateAfrican
American
Rate
American
Indian Rate
Hispanic
Rate
Other Rate
Figure 36: 2014 Infant Mortality (per 1,000 live births)
Orange County North Carolina
47
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to Maternal and
Infant Health.
Agency /
Organization /
Initiative
Advocacy /
Community
Support
Breastfeedi
ng Support
Care
Coordinat
ion 4
Children
(CC4C) Education
Family
Home
Visiting
Family
Planning /
Contracep
tion
Financial
Assistan
ce
Program
s /
Support
Infant
/ Child
Care
Immigra
nt &
Refugee
Support
Pregnancy
Care
Manageme
nt /
Maternal
Care
Substan
ce
Abuse
Women,
Infant,
Children
(WIC)
Adolescent
Parenting
Program X X X X
Chapel Hill -
Carrboro YMCA X X X
Chapel Hill
Tubal Reversal
Center X X
Head
Start/Early
Head Start X X X
Kidscope X X X
Orange County
Department of
Social Services X X X X
Orange County
Health
Department X X X X X X X X X X X X
Orange County
Partnership for
Young Children X X X
Period of
Purple Crying X X
Planned
Parenthood X X X X X
Text4baby X X
UNC Health
Care X X X X X X X X
UNC Horizons X X X X X X
Women’s Birth
and Wellness
Center X X X X X
48
Environmental Health
Environmental Health includes air quality, drinking, and ground water quality; food safety and
protection; sewer systems; solid waste management, and lead hazards.
Air Quality
The US Environmental Protection Agency (EPA) calculates the Air Quality Index (AQI) for six major air
pollutants regulated by the Clean Air Act: 1) ground-level ozone, 2) particle pollution (also known as
particulate matter), 3) carbon monoxide, 4) sulfur dioxide, 5) nitrogen dioxide, and 6) lead73.
On days where AQI reaches higher than 100, persons sensitive to air pollutants may experience health
effects due to ozone exposure. Such exposure can lead to respiratory symptoms, disruption in lung
function, and inflammation of airways.74
Ozone is one of the 6 major air pollutants measured in the AQI that has been linked to increased
frequency of asthma attacks and use of health care services.
Ozone exposure may also affect respiratory system development in very young children.75
In Orange County, there were 28 days where the heat index was over 95 degrees in 2015, compared
to 20 the year before. The average number of days for the 5 years prior to 2014 was 35 days.
We have seen an increase in the rate of Melanoma (skin) cancer in the past 10 years from
approximately 15 cases per 100,000 people in 2001 to 37 cases per 100,000 people in 2012.
While also increasing, NC has not seen the steep increase that Orange County has seen, with a
statewide rate of 23 per 100,000 people in 2012 (shown in figure 37).
White non-Hispanic males show a higher incidence of melanoma than white non-Hispanic females.
Numbers were too few to establish a rate for other races or ethnicities (shown in figure 38).
Figure 37: Figure 38:
49
Drinking Water Quality
Contaminants in water and air can have adverse health consequences where both short-term and
chronic exposure to pollution can present serious health risks. The National Primary Drinking Water
Regulations (NPDWRs or primary standards) are legally enforceable standards that apply to public water
systems. 76
The safety of drinking water can be measured in terms of whether Maximum Contaminant Levels (MCL)
are met for various pollutants present in water that could affect health. MCL standards for drinking
water quality are set by EPA. An MCL is the legal threshold limit on the amount of a substance that is
allowed in public water systems under the Safe Drinking Water Act.
A group of survey respondents expressed concern with contaminated drinking water within their
apartment complex.
A group of survey respondents within the northern part of the county experience challenges with
drinking water due to storm water runoff.
Water Supplies
Citizens living in the municipal areas of Orange County and in some limited unincorporated areas are
served by the following community public water systems:
o Orange Water and Sewer (OWASA)
o Town of Hillsborough
o Orange-Alamance Water (OAW)
o Town of Mebane
o City of Durham
Of the Orange County populations served by community water systems, approximately 78% are
served by the Orange Water and Sewer Authority (OWASA).
Water Supplies for residents that are not served by either a municipal public water supply or a public
water supply well are served by a private drinking water well. Public Water Supplies whether a
municipal system or public water supply well are regulated by the North Carolina Department of
Environment and Natural Resources (NC DENR) and private drinking water wells are regulated by the
Orange County Health Department. Well siting, permitting, inspections and water sampling are carried
out by the Environmental Health staff and shown in table 14.
Table 14: Number of New Wells and Water Samples Collected Over a 3-Year Period
Year New Wells Completed Water Samples Collected for
Analysis
2013 149 1,100
2014 133 1,219
2015 166 1,176
Water samples are sent to the NC State Laboratory of Public Health for analysis. The private well owner
is provided a Health Risk evaluation of the water by Environmental Health staff after results are
received. Recommendations in the Health Risk report are based on EPA MCL and NC Health based
standards (2L) standards.
50
Lead Hazards
Approximately 250,000 children in America aged 1-5 years have blood lead levels greater than 10
micrograms of lead per deciliter of blood (ug/dL). This is the level at which the CDC recommends
public health actions be initiated.
Lead exposure is especially harmful to children under six years of age, because of their constant
hand-to-mouth activity, where it affects their developing brains and nervous systems77.
Ingesting or swallowing lead-contaminated materials is the primary way that children get lead
poisoning at home.
Lead exposure of women of child-bearing age can also adversely affect developing fetuses during
pregnancy.
Children exposed to lead can have stunted growth, mental problems including low IQ or learning
problems, and severe lead poisoning which can cause seizures, coma, and even death. Typical sources of
lead exposure may include: painted or plastic toys, lead-based paint in older homes which can chip or
form a harmful dust, soil, vinyl and plastic products, imported candy, lead-glazed pottery, fishing tackle,
and drinking water pipes with lead-based solder.
The Childhood Lead Poisoning Prevention Program (CLPPP) tracks the number and rate of children in the
target populations who are required to be screened for blood lead levels. Table 15 shows the number of
children under age 6 with blood lead levels greater than 10ug/dL for Orange County compared to NC.
Table 15: Number of Children under the Age of 6 with a Blood Lead > 10 ug/dL
Year
NC Orange County
Tested
> 10 *
Confirmed
> 10 **
Tested
> 10
Confirmed
> 10
2007 1,074 271 12 5
2008 932 216 11 2
2009 583 181 5 1
2010 519 170 2 0
2011 461 127 1 1
51
Below you will find a list of (non-exhaustive) Orange County initiatives and activities as they relate to Environmental
Health.
Agency /
Organization /
Initiative
Advocacy /
Community
Support Air Drought
Ground
water Lead Research Reservoir
Septic
/
Sewer
Water
(Drinking,
Public,
Storm,
etc.)
H2Orange X X X X X
N.C. Childhood Lead
Poisoning
Prevention Program X X
N.C. Department of
Environment and
Natural Resources
Division of Air
Quality X X X
Orange County
Health Department X X X X X X X X X
Orange Soil and
Water Conservation
District X X X X
Orange Water and
Sewer Authority X X X X
Orange-Alamance
Water System, Inc X X X
UNC Center for
Environmental
Health and
Susceptibility X X
Appendix
List of Appendices:
Orange County Population Health Dashboards .................................................................... Appendix A
Public Health Dashboard FAQ and Sources .......................................................................... Appendix B
Healthy North Carolina 2020 Objectives .............................................................................. Appendix C
Community Health Assessment Team Members .................................................................. Appendix D
Community Health Assessment Survey Volunteers .............................................................. Appendix E
Map of Survey Locations ....................................................................................................... Appendix F
Notification Postcard Sent to Randomly Selected Households ............................................ Appendix G
2015 Orange County Community Health Opinion Survey, English ....................................... Appendix H
2015 Orange County Community Health Opinion Survey, Spanish ...................................... Appendix I
Focus Group Guide and Demographics, English ................................................................... Appendix J
Focus Group Guide and Demographics, Spanish .................................................................. Appendix K
Youth Focus Group Guide and Demographics ...................................................................... Appendix L
Community Listening Session Flyers, English and Spanish ................................................... Appendix M
References ............................................................................................................................ Appendix N
Appendix A: Orange County Population Health Dashboards
Orange County, NC
2016 Population Health Dashboards
Summary: Orange County performs well on most Chronic Disease indicators compared to NC, the US, Peers, and available Target
values. While the number of deaths due to diseases of the heart has increased in the past 3 years, the Age-Adjusted mortality rate
has been declining, implying heart disease mortality is generally improving or stable. However, prevalence of chronic diseases, such
as Cardiovascular Disease and Diabetes has increased in the last decade. Breast Cancer Incidence and Mortality in Orange County
continues to be higher than all corresponding benchmarks. Preventative cancer screening rates are lower than peers and targets.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Diseases of the HeartDiseases of the HeartDiseases of the HeartDiseases of the Heart
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Cardiovascular Disease Prevalence 7.6%NA 5.1%-8.6%9.2%26.8%
Cardiovascular Disease Mortality Rate182.6161.5 NA -210.2235.7 NA
Diseases of the Heart Mortality Rate118.4103.4123.2 ↓148.7165.9105.4
Heart Disease Crude ED Rate per 10,000 person-yrs235.2 NA 236.8 SAME 295.4423.0 NA
Circulatory Crude ED Rate per 10,000 person-yrs541.7 NA 566.8 ↓674.41073.4 NA
Hypertension Crude ED Rate per 10,000 person-yrs352.0 NA 384.9 ↓399.7759.4 NA
StrokeStrokeStrokeStroke
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Stroke Mortality Rate 34.134.832.9 SAME 34.943.040.8
Stroke Crude ED Rate per 10,000 person-yrs35.7 NA 38.9 ↓17.555.4 NA
DiabetesDiabetesDiabetesDiabetes
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Adult Diabetes Prevalence*7.3%8.6%5.3%-8.6%11.4%9.3%
Diabetes Mortality Rate 13.0 NA 11.4 ↑15.322.123.9
CancerCancerCancerCancer
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Cancer Incidence Rate 459.3 NA 407.5 SAME 432.4483.4454.8
Cancer Mortality Rate 158.6161.4156.0 SAME 161.1171.8171.2
Female Breast Cancer Incidence Rate157.9 NA 164.5 ↓131.2157.9124.8
Female Breast Cancer Mortality Rate22.120.723.3 SAME 17.821.621.9
Lung Cancer Mortality Rate 56.9 NA 59.1 ↓66.470.958.7
Lung Cancer Incidence Rate 43.945.542.1 ↑46.050.647.2
Colorectal Cancer Incidence Rate 34.3 NA 32.6 SAME 31.738.542.4
Colorectal Cancer Mortality Rate 10.910.110.6 SAME 11.414.315.5
Prostate Cancer Mortality Rate 17.721.820.1 ↓18.121.421.4
Clinical Preventative ServicesClinical Preventative ServicesClinical Preventative ServicesClinical Preventative Services
ScoreIconCurrentTargetPreviousProgressPeerNCUS
% Colorectal Cancer Screening*61.4%70.5%NA -71.0%68.0%65.0%
% Women who received Mamogram (50+)*80.9%81.1%NA -80.0%81.5%80.0%
Progress Orange County Trend Compare to
ProgressOrange CountyTrendCompare to
Progress Orange County Trend Compare to
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
Data Notes:
*Due to changes in survey methodology and overlapping confidence intervals, BRFSS data cannot be compared to previous years
Rates are per 100,000 unless otherwise noted See the Public Health Dashboard FAQ Document for more on data methodology.
Sources: NC SCHS, NC DETECT, BRFSS, SEER; Rates are per 100,000 unless otherwise noted
Data points are the most current measures from multiple sources (available on request).
D
Orange County, NC
2014* Population Health
Dashboard
Source: 2013 DHHS HIV/STD Surveillance Report
Summary:
Orange County performs well on most sexually transmitted disease (STD) indicators compared to NC, the US, Peers,
and available Target values. However, the incidence of STDs has increased compared to previous years. Early Syphilis
and HIV Rates in particular are higher for Orange County than our peers.
Sexually Transmitted Infections (STIs)Sexually Transmitted Infections (STIs)Sexually Transmitted Infections (STIs)Sexually Transmitted Infections (STIs)
IconCurrentTargetPreviousProgressPeerNCUS
% age 15-24 testing positive for Chlamydia of those tested8.5%8.7%#N/A-10.0%10.9%15.6%
Chlamydia Incidence Rate (/100,000)340.7#N/A330.6 ↑367.6496.5446.6
Early Syphylis Rate (/100,000)3.6#N/A2.2 ↑2.76.910.9
Gonorrhea Incidence Rate (/100,000)82.6#N/A61.6 ↑109.1140.1106.1
HIV/AIDSHIV/AIDSHIV/AIDSHIV/AIDS
Icon Current Target Previous Progress Peer NC US
AIDS Incidence Rate (/100,000)5.112.41.4 ↑7.19.28.4
HIV Infection Rate (/100,000)12.322.210.9 ↑9.715.615.0
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
↑↓Positive trend
↑↓Negative trend
Neutral trend
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
2013
2013
Data Notes:
*Due to changes in the presentation of surveillance data in annual report tables (county of residence to county of diagnosis), current
rates for many sexually transmitted diseases cannot be compared to historical data. Therefore, this dashboard compares data from
2013 to the previous year, 2012. Orange County cases from 2014, and preliminary 2015 case numbers can be found in lower table
See the Public Health Dashboard FAQ Document for more information on data methodology.
Sexually Transmitted Disease Cases among Orange County residents by year 2013-2015[i]
2013 2014 2015
Gonorrhea cases 114 112 183
Chlamydia cases 470 472 684
Syphilis cases 3 17 13
Newly reported HIV infections among
OC residents
16 14 12
Newly reported AIDS cases among OC
residents
8 10 8
*The above numbers are preliminary and were obtained from the 2015 fourth quarter report, annual numbers were not available.
Orange County, NC
2016 Population Health Dashboards
Summary:
Injury and Violence statistics have remained generally stable in recent years. However, crime rates have decreased
over the past decade. Alcohol related vehicle injuries are an area of concern for Orange County. Both alcohol related
crash rates and reported drinking and driving behaviors are more prevalent than our peers, the state, and the US.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Mental Health and EmergenciesMental Health and EmergenciesMental Health and EmergenciesMental Health and Emergencies
ScoreIconCurrentTargetPreviousProgressPeerNCUS
Avg # Poor Mental Health Days / Month*2.52.82.9 ↓3.33.7 NA
Suicide Mortality Rate 10.48.312.2 ↓14.312.413.0
Mental Health Crude ED Rate per 10,000 person-yrs82.182.886.2 ↓94.3104.6 NA
Substance Abuse Crude ED Rate per 10,000 person-yrs 121.2 NA 121.8 SAME 136.2139.4 NA
ProgressOrange CountyTrendCompare to
Unintentional InjuriesUnintentional InjuriesUnintentional InjuriesUnintentional Injuries
IconCurrentTargetPreviousProgressPeerNCUS
Other Unintentional Mortality Rate (Age-Adj)24.436.421.8 ↑32.229.639.1
% Adults 45+ experienced fall(s) in past 3 months*18.6%NA 11.0%-16.8%17.5%NA
% Adults ever experienced traumatic brain injury*9.3%NANA -16.8%4.5%8.5%
Drug Overdose and PoisoningDrug Overdose and PoisoningDrug Overdose and PoisoningDrug Overdose and Poisoning
IconCurrentTargetPreviousProgressPeerNCUS
Drug Overdose Mortality Rate 5.7 NA 10.0 ↓9.712.314.6
Opioid Overdose Mortality Rate 3.6 NA 7.1 ↓4.48.05.3
Drug Overdose Crude ED Rate per 10,000 person-yrs14.5 NA 12.7 SAME 16.621.0 NA
Motor Vehicle Safety and AccidentsMotor Vehicle Safety and AccidentsMotor Vehicle Safety and AccidentsMotor Vehicle Safety and Accidents
IconCurrentTargetPreviousProgressPeerNCUS
Crash Injuries Per 1000 People 7.116.946.94 SAME 8.5211.737.52
Unintentional Motor Vehicle Mortality Rate 8.0 NA 9.1 ↓9.713.510.3
% Crashes that are Alcohol Related 5.7%4.7%5.8%SAME 4.5%4.2%9.0%
% Adults who drove after drinking in past 30 days*7.7%NA 1.8%-3.6%2.4%1.8%
% High schoolers who drove after drinking in past 30 days(CHCCS)**9%NA 9%SAME NA 6%10%
% High schoolers who texted while driving in past 30 days(CHCCS)**23%NANA -NA 34%41%
Violence and CrimeViolence and CrimeViolence and CrimeViolence and Crime
IconCurrentTargetPreviousProgressPeerNCUS
Violent Crime Rate per 100,000 151.1 NA 146.9 SAME 143.7333.0365.5
Assault Rate per 100,000 95.7192.087.4 ↑102.0221.6232.1
Rape Rate per 100,000 15.6 NA 12.9 ↑23.818.138.5
Homicide Rate per 100,000 1.45.50.7 ↑1.85.54.5
% High schoolers who had been injured in a fight (CHCCS)**3.6%NA 6.5%↓NA 3.0%3.1%
% High schoolers who experienced dating violence (CHCCS)**4.8%NA 9.2%↓NA 9.4%10.3%
% High schoolers who experienced forced intercourse (CHCCS)**6.8%NA 6.7%SAME NA 8.9%7.3%
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
ProgressOrange CountyTrendCompare to
Sources: BRFSS, YRBS, NCDOT, NCSBI, NC SCHS, NC DETECT
Data points are the most current measures from multiple sources (available on request).
Data Notes:
*Due to changes in survey methodology and overlapping confidence intervals, BRFSS data cannot be compared to previous years
**Confidence intervals for YRBS trend data are unavailable to assess significance of trends over time.
Rates are per 100,000 unless otherwise noted. See the Public Health Dashboard FAQ Document for more on data methodology.
Orange County, NC
2016 Population Health Dashboards
Summary:
Orange County performs well on most indicators of Maternal and Infant Health, including having the lowest teen
pregnancy rate in the state. However, many disparities exist for these indicators by race and ethnicity. Future
dashboards will look into examining disaggregated data and these disparities in more detail.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
Significant change
from previous
No trend
Trend cannot be assessed
Positive trend
Negative trend
Neutral trend
Sources: NC SCHS
Data points are the most current measures from multiple sources (available on request).
Birth OutcomesBirth OutcomesBirth OutcomesBirth Outcomes
IconCurrentTargetPreviousProgressPeerNCUS
Infant Mortality Rate (/1,000)4.96.34.6 SAME 1.37.16.1
% Low Birthweight Babies (<2500 grams)*6.0%7.4%7.0%↓7.5%8.9%8.0%
% Very Low Birthweight Babies (<1500 grams)*0.7%1.4%1.6%↓0.9%1.7%1.4%
% Mothers Smoking while pregnant6.6%1.4%6.0%↑3.4%10.6%10.0%
% Preterm Births ( <37 Wks Gestation)*9.0%11.4%9.6%SAME 10.3%11.4%11.4%
Unintended PregnancyUnintended PregnancyUnintended PregnancyUnintended Pregnancy
IconCurrentTargetPreviousProgressPeerNCUS
Teen Pregnancy (Rate/1,000)9.6#N/A12.4 ↓24.032.326.5
Repeat Teen Pregnancy Rate8.7%#N/A25.0%↓13.5%22.4%18.3%
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
ProgressProgressProgressProgressOrange CountyOrange CountyOrange CountyOrange CountyTrendTrendTrendTrendCompare toCompare toCompare toCompare to
Data Notes:
*Low birth weight and preterm birth percentages calculated from 2014 birth data query. Official percentages will be available from
the NC SCHS in the 2014 Pocket Guide, expected to be published in early 2016. See the Public Health Dashboard FAQ Document for
more on data methodology.
Appendix B: Public Health Dashboard FAQ and Sources
Public Health Dashboard Companion Document
March 2016
60
In addition to an overview of OCHD public health dashboards, this document contains:
1) FAQs, 2) Explanation of some data set considerations, and 3) 2016 Public Health Dashboard source information
Purpose:
To provide an executive level view of how the county is performing on indicators in major public health
content areas as compared to the state, nation, peers, and available targets or goals. Icons provide quick
reference to indicators of note, and how Orange County compares to these benchmarks.
Content Areas:
Access to Care; Chronic Disease; Injury and Violence; Maternal and Infant Health; Physical Activity and
Nutrition; Poverty Mitigation; Sexually Transmitted Diseases; Substance Abuse and Mental Health;
Tobacco and Respiratory Disease;
Data Disclaimer:
These dashboards are intended to be a starting point for collecting a number of related indicators in one
place. However, because these data come from a variety of different data sources, each indicator will
have its own set of limitations and considerations based on the collection and analysis methodology for
that data source. It is important to understand the methodology utilized for the indicators you may be
interested in and incorporate corresponding limitations into any of your own reporting. References
and/or more detailed information on the sources for particular data points are provided in summary at
the end of this document, and additional information may be provided on request.
FAQs:
Q: What sources do you use for your data?
The dashboards use the most recent and available data/statistics from a variety of different sources, including:
American Community Survey (ACS) and Decennial Census from the Census Bureau;
Behavioral Risk Factor Surveillance Survey (BRFSS);
The Cecil G. Sheps Center for Health Services Research (Sheps Center);
Center for Disease Control and Prevention (CDC);
Department of Health and Human Services (DHHS);
Henry J. Kaiser Family Foundation
Morbidity and Mortality Weekly Report and Statistics (MMWR);
National Center for Education Statistics (NCES);
NC Controlled Substance Reporting System (CSRS);
North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT);
North Carolina Electronic Disease Surveillance System (NC EDSS);
North Carolina Public Schools;
North Carolina State Department of Public Safety (NC DPS) and Bureau of Investigation (NCSBI);
North Carolina State Center for Health Statistics (NC SCHS);
North Carolina Department of Transportation (NC DOT)
Pediatric Nutrition Surveillance System (PedNSS);
Small Area Health Insurance Estimates (SAHIE);
Surveillance, Epidemiology, and End Results Program (SEER) through The National Cancer Institute;
UNC School of Government Hunger Research;
Youth Risk Behavior Survey (YRBS);
Sources for the 2016 Public Health Dashboards can be found at the end of this document.
61
Q: What years are your data from?
The data included in these dashboards are the most up to date data available for Orange County. In
some cases, there may be more recent data available for peers, the state, or the US; however,
benchmark values are selected from the same year as the Orange County data, for consistency of
comparison. In some cases, data points from one geography may represent multiple year rates (such as
3-year or 5-year rates), whereas other geographies may show only 1-year rates. In these cases, the
smaller geography (counties) uses multiple years of data to improve statistical power through a larger
sample size, whereas US numbers are large enough in a single year to report a 1-year rate.
Q: How do you determine which indicators to include in your dashboards?
The over-arching content areas selected for our dashboards are based on current county priority areas
and on the topic area categories included in the Healthy People 2020 and Healthy North Carolina 2020
Objectives. In order to present a meaningful set of data that develops an executive level picture for what
is happening in our county’s health, we only include indicators that meet several criteria. These criteria
help contextualize county measures by relating them to comparable benchmarks. Meaning, a number by
itself does not give you any frame of reference unless you have other measures to compare it with.
We aim to select measures that are meaningful to public health and:
1) annual measures
2) updated on a regular basis
3) available at the county level
4) have existing objectives, targets, or benchmarks (such as the HP2020 or HNC2020 Objectives)
5) are commonly used measures across geographies (other counties, the state, the US)
In some cases, an indicator may meet several but not all of these criteria. In general, an indicator must
meet a majority of these criteria to be included in the dashboard.
Q: What do the circle, triangle, and square icons mean?
The performance icons serve as
“at-a-glance” guides that allow
the reader to scan the dashboard and identify indicators for which the county is performing either
better or worse than the majority of available benchmarks (target, previous, peer, NC and US).
It is important to note that these icons serve as a starting point for conversations, but there are many
stories to tell behind each indicator. For example, an indicator with a green circle may not alert the
reader to health disparities for a specific demographic group within an indicator data set. The absence of
disparity measures is a general limitation of this indicator set, but the department hopes to incorporate
more data related to health disparities in future dashboard iterations.
Performing better than four or more benchmarks
Performing better than two or three benchmarks
Performing better than one or no benchmarks
Benchmarks include Target, Previous, Peer, NC, and US
62
Q: How do you determine whether a trend is increasing, decreasing, or the
same?
As most of these indicators currently only observe two data points in time, it is difficult to identify a true
change in trend (a second limitation of this data set). Observing whether confidence intervals or margins
of error for the two observed values overlap from one year to another represents the best method for
determining if there is a statistical difference between previous and current indicator values. However,
confidence intervals are not always readily available in reports. In addition, when there are changes is
survey or data reporting methodology, current measures may not be comparable to previous years. In
these cases, it is indicated that the trend cannot be assessed.
For the purposes of this dashboard, we have adopted three “rules of thumb” for identifying a threshold
for change in trend, as well as if that change appears significant, in the absence of confidence intervals
or margin of error.
• A difference of one percentage point or greater from a surveyed population (such as
BRFSS/YRBS, represented by a percentage value) is deemed as a change in trend. For example,
a change from 7.0% to 8.4% would represent an increasing trend, whereas a change from 7.0%
to 7.8% would be considered the same. Whether this trend is “positive” or “negative” (signified
by green or red colors) depends on the nature of the indicator. If we are observing an increase in
diabetes that would be a negative trend, but an increase in physical activity would be a positive
trend.
• A difference in a rate that represents a 1% increase or decrease of the previous rate value
would also be deemed as a change in trend. For example, a rate difference from 3.1 to 2.7 per
100,000 people would represent a -12.9% difference (3.1-2.7= .4/3.1 = .129). This would
represent a decrease in trend. However, a rate difference from 256.3 to 255.9 per 100,000
people would only represent a -0.2% difference (rounded), and would thus be considered the
same as the previous year for the purposes of this dashboard (256.3-255.9= .4/256.3 = .0016).
• For rates greater than 5, green and red fill backgrounds signify a greater than 20% increase or
decrease in rate from previous, noted in this case as a significant change in trend from previous.
63
(more detailed considerations to come in future dashboard iterations)
Sources: Urban Institute, NC DETECT
Decennial Census
Prior to 2010, the decennial census included basic information on the 100 percent sample (Summary File
1, or SF1) as well as detailed information on a subset of the population receiving the long form, which
includes additional questions. Beginning in 2010, the decennial census only provides data on basic
demographic information (SF1), as the long form has been replaced by the American Community Survey
(ACS) discussed below.
Frequency: Every 10 years.
Geographies: Blocks, block groups, census tracts, counties, county subdivisions, zip code tabulation
areas.
Variables: Total population, age, sex, race and ethnicity, household type, tenure, vacancy.
Strengths: Data are available at small geographies (down to the block level). Data come from a census
rather than a sample survey, with results in smaller margins of error.
Drawbacks: Because the decennial census occurs only once every 10 years, its data quickly become
outdated. Data are limited to a small set of variables.
Additional Information: The Census Bureau may draw new geographic boundaries for a new
decennial census. Consequently, when using the decennial census from multiple years, Promise
Neighborhoods must first ascertain that geographic boundaries have not changed. Moreover, the
decennial census can change how a question is phrased, which might change the indicator over time.
(For example, in 2010 the Census Bureau changed how it asked respondents about race and ethnicity.)
Because of this, data might not be comparable from year to year or between the decennial census and
the ACS (discussed below). Users should check the Census Bureau web site
(http://2010.census.gov/2010census/) for any changes in phrasing and their effects on comparability.
Data Availability: Data for specific geographies can be found using FactFinder
http://factfinder2.census.gov).
American Community Survey
The American Community Survey (ACS) is an ongoing statistical survey run by the U.S. Census Bureau,
replacing the long form in the decennial census. The ACS has approximately 250,000 respondents
monthly, totaling 3 million per year. ACS data are particularly useful, as it is publicly available and offers
indicators on several topics.
Frequency: Survey data are collected regularly. Because the ACS covers a smaller sample size than the
decennial census, these data files come in one-year, three-year, and five-year averages. For example,
data from the 2008–2010 sample will represent averages over the 36-month span.
Geographies: Census tracts, county subdivisions, zip code tabulation areas, counties. Only the five-year
averages have data down to the census tract level.
Variables: ACS data are collected on both persons/households and housing characteristics. Data on
persons/households includes age, sex, ancestry or immigration status, disability, work commutes,
education, employment, family composition, income, language, poverty, and race/ethnicity. Data on
housing include financial characteristics such as rent and mortgage costs, as well as physical
characteristics such as the number of units in the building and the age of the housing unit.
Strengths: Compared to the decennial census, ACS data are available on more topics and are updated
64
more frequently.
Drawbacks: Because of the smaller ACS sample sizes, users must pay special attention to standard
errors, as they can be particularly large. In addition, when using data that represent multiyear averages,
users are advised to not compare overlapping years (e.g., 2005–2009 data should not be compared to
2006–2010 data).
Additional Information: The Census Bureau has created a useful guide for ACS data
(http://www.census.gov/acs/www/Downloads/handbooks/ACSResearch.pdf).
Data Availability: Data can be downloaded for specific geographies using FactFinder
(http://factfinder2.census.gov/), or flat files can be downloaded for multiple areas
(http://www.census.gov/acs/www/data_documentation/data_via_ftp/)
North Carolina Disease Event Tracking and Epidemiologic Collection
Tool
NC DETECT is North Carolina's statewide syndromic surveillance system. NC DETECT was created by
the North Carolina Division of Public Health (NC DPH) in 2004 in collaboration with the Carolina Center
for Health Informatics (CCHI) in the UNC Department of Emergency Medicine to address the need for
early event detection and timely public health surveillance in North Carolina using a variety of secondary
data sources. Authorized users are currently able to view data from emergency departments,
the Carolinas Poison Center, and the Pre-hospital Medical Information System (PreMIS), as well as pilot
data from select urgent care centers.
NC DETECT is designed, developed and maintained by CCHI staff with funding by the NC DPH. New
functionality is added regularly based on end user feedback.
Please send questions to ncdetect@listserv.med.unc.edu.
Frequency: Real-time, monthly, and annual reports.
Geographies: By hospital, County, and in some cases Zipcode
Variables: Number of visits, age, sex, payer type, ICD diagnosis codes, keywords.
Strengths: Rich data set for developing aggregate measures and real-time nature of data is informative
for situational awareness and emergency response.
Drawbacks: Because different fields and agencies may define indicators or conditions differently, it can
be difficult to establish standard case definitions for syndromes.
Data Availability: Data and reports can be found at http://www.ncdetect.org/
If you have any questions or comments regarding the methodology and/or data contained in these
dashboards, please contact Allison Young, Health Informatics Manager, at
ayoung@orangecountync.gov.
65
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68
Appendix C: Healthy North Carolina 2020 Objectives
69
Healthy NC 2020 Objective Orange County North Carolina Target
Tobacco Use
Decrease the percentage of adults who are current smokers 16.8% 19.1% (2014) 13.0%
Decrease the percentage of high school students reporting current
use of any tobacco product 9% 22.5% (2011) 15.0%
Decrease the percentage of people exposed to secondhand smoke
in the workplace in the past seven days. 6.4% 9.7 %(2014) 0%
Physical Activity and Nutrition
Increase the percentage of high school students who are neither
overweight nor obese 78.0% 72.3% (2013) 79.2%
Increase the percentage of adults getting/ meeting CDC Aerobic
Recommendations 51.7% 48.1% (2013) 60.6%
Increase the percentage of adults who consume fruit one or more
times per day. 68.0% (2015)* 57.1% (2013) 69.7%
Increase the percentage of adults who consume vegetables one or
more times per day. 68.0% (2015)* 76.3% (2013) 84.7%
Injury and Violence
Reduce the unintentional poisoning mortality rate (per 100,000
population) 6.7(2014) 12.5 (2014) 9.9
Reduce the unintentional falls mortality rate (per 100,000
population) 18.6 10.0 (2014) 5.3
Reduce the homicide rate (per 100,000 population) 1.4 5.6 (2014) 6.7
Maternal and Infant Health
Reduce the infant mortality racial disparity between whites and
African Americans 3.76 (2014) 2.39 (2014) 1.92
Reduce the infant mortality rate (per 1,000 live births 4.9 7.1 (2014) 6.3
Reduce the percentage of women who smoke during pregnancy 6.6% 9.8%(2014) 6.8%
Sexually Transmitted Disease and Unintended Pregnancy
Decrease the percentage of pregnancies that are unintended County data
not available 42.7% (2011) 30.9%
Reduce the percentage of positive results among individuals aged
15 to 24 tested for chlamydia 8.5% (2011) 10.8%(2014) 8.7%
Reduce the rate of new HIV infection diagnoses (per 100,000
population) 12.3 (2013) 16.0 (2013) 22.2
Substance Abuse
Reduce the percentage of high school students who had alcohol on
one or more of the past 30 days 32% 32.2% (2013) 26.4%
Reduce the percentage of traffic crashes that are alcohol-related 6.1% 4.8% (2014) 4.7%
Reduce the percentage of individuals aged 12 years and older
reporting any illicit drug use in the past 30 days 9% 7.5% (2012-13) 6.6%
Mental Health
Reduce the suicide rate (per 100,000 population) 10.4 13.0 (2014) 8.3
Decrease the average number of poor mental health days among
adults in the past 30 days 2.5 3.6 (2014) 2.8
Reduce the rate of mental health-related visits to emergency
departments (per 10,000 population) 82.1 104.5
(2012) 82.8
Oral Health
Increase the percentage of children aged 1–5 years enrolled in 55.7% (2009-58.0% (2013) 56.4%
70
Medicaid who received any dental service during the previous 12
months
11)
Decrease the average number of decayed, missing, or filled teeth
among kindergartners 0.9 (2009-11) 1.5
(2009-10) 1.1
Decrease the percentage of adults who have had permanent teeth
removed due to tooth decay or gum disease
30.2% (2009-
11) 49.1% (2014) 38.4%
Environmental Health
Increase the percentage of air monitor sites meeting the current
ozone standard of 0.075 ppm 0* 95.6% (2011-
13) 100%
Increase the percentage of the population being served by
community water systems (CWS) with no maximum contaminant
level violations (among persons on CWS
County data
not available 97.9% (2013) 95.0%
Reduce the mortality rate from work-related injuries (per 100,000
equivalent full-time workers)
County data
not available 2.5 (2013) 3.5
Infectious Disease and Foodborne Illness
Increase the percentage of children aged 19–35 months who
receive the recommended vaccines
County data
not available 76.6% (2013) 91.3%
Reduce the pneumonia and influenza mortality rate (per 100,000
population) 13.7 17.1 (2014) 13.5
Decrease the average number of critical violations per
restaurant/food stand 1.9% (2014-15) 6.5 (2011) 5.5
Social Determinants of Health
Decrease the percentage of individuals living in poverty 14.1% 18.6% (2013) 12.5%
Increase the four-year high school graduation rate 88% 85.4% (2014-
15) 94.6%
Decrease the percentage of people spending more than 30 percent
of their income on rental housing 53% 46.3% (2014) 36.1%
Chronic Disease
Reduce the cardiovascular disease mortality rate (per 100,000
population) 182.6 216.5 (2014) 161.5
Decrease the percentage of adults with diabetes 7.3% 10.8% (2014) 8.6%
Reduce the colorectal cancer mortality rate (per 100,000
population) 10.9 14.2 (2014) 10.1
Cross-cutting
Increase average life expectancy (years) 82 78.3 (2014) 79.5
Increase the percentage of adults reporting good, very good, or
excellent health 93% (2015)* 81.0% (2014) 90.1%
Reduce the percentage of non-elderly uninsured individuals (aged
less than 65 years) 15.3% 15.2% (2014) 8.0%
Increase the percentage of adults who are neither overweight nor
obese 52.8% (2011) 34.4% (2014) 38.1%
*2015 Community Health Assessment Survey results: 68% of respondents reported eating 5 or more cups of fruits and vegetables a
week; 93% of respondents reported their general health as Excellent, Very Good, or Good
*Under Environmental Health: There are no air monitor sites in Orange County
71
Appendix D: Community Health Assessment Team Members
72
CHA Leadership Team (CHALT)
The CHALT, known as the governing body, was made up of diverse individuals from the Orange County
Health Department, UNC Hospital, United Way of the Greater Triangle, Cardinal Innovations, Orange
County Board of Health, Piedmont Health Services, Orange County Schools, Chapel Hill – Carrboro City
Schools, Freedom House Recovery Center, Orange County Emergency Management, Orange County
Department on Aging, Orange County Board of County Commissioners, and Community Members.
• Ashley Mercer, Orange County Health
Department
• Bernadette Pelissier, Orange County
Board of County Commissioners
• Cindy Bucy, Cardinal Innovations
• Donna King, Orange County Health
Department
• Dr. Collen Bridger, Orange County
Health Department
• Janaki Nicastro, Freedom House
Recovery Center
• Linda Joseph, Chapel Hill Carrboro City
Schools
• Liska Lackey, Orange County Board of
Health
• Michael Gilbert, Orange County Schools
• Mike Fliss, Community Member
• Misty Drake, Piedmont Health Services
• Myra Austin, Orange County
Department on Aging
• Pam McCall, Orange County Health
Department
• Spencer Lindgren, Orange County
Emergency Management
• Suzanne Deobold, United Way of the
Greater Triangle
• Tom Maltais, UNC Health Care
Communication Team
The Communication Team was responsible for communication efforts around every aspect of the CHA
process. This small group developed general and universal talking points and utilized professional and
personal connections to reach various channels. The Communication Team included individuals from
Freedom House Recovery Center, UNC Hospital, Piedmont Health Services, a Community Resident and
the Health Department.
• Anne-Marie Vanaman, Freedom House
Recovery Center
• Ashley Mercer, Orange County Health
Department
• Debra Markley, Piedmont Health
Services
• Donna King, Orange County Health
Department
• Laura Wenzel, Community Resident
• Tom Maltais, UNC Health Care
73
Community Engagement Team
The Community Engagement Team worked closely with the Communication Team and was responsible
for ensuring that the true needs of the community were identified, accurately represented and
addressed. The Community Engagement Team consisted of individuals from Cardinal Innovations,
Orange County Board of Health, Orange County Emergency Management, Orange County Health
Department, and Piedmont Health Services.
• Ashley Mercer, Orange County Health
Department
• Cindy Bucy, Cardinal Innovations
• Donna King, Orange County Health
Department
• Heather Miranda, Piedmont Health
Services
• Liska Lackey, Orange County Board of
Health
• Marni Holder, Piedmont Health Services
• Spencer Lindgren, Orange County
Emergency Management
• Susan Clifford, Orange County Health
Department
• Victoria Hudson, Orange County Health
Department
Data Team
The Data Team was responsible for identifying, collecting and analyzing primary and secondary data,
designing the survey and geographic sampling, and integrating data into the final document. This team
was made up of individuals from the Health Department, OC Information Technology, OC Planning,
Carrboro Farmer’s Market, and UNC Chapel Hill.
• Adrien Wilke, University of North
Carolina at Chapel Hill
• Allison Young, Orange County Health
Department
• Ashley Mercer, Orange County Health
Department
• Bradley Saul, University of North
Carolina at Chapel Hill
• Brennan Bouma, University of North
Carolina at Chapel Hill
• Brian Carson, Orange County Planning
• Diana Sanchez, University of North
Carolina at Chapel Hill
• Hardik Patel, Orange County
Information Technology
• Jim Northrop, Orange County
Information Technology
• Kristin Voltzke, University of North
Carolina at Chapel Hill
• Margaret Krome-Lukens, Carrboro
Farmer’s Market
• Mike Fliss, Community Member
• Paula Strassle, University of North
Carolina at Chapel Hill
• Rahul Gondalia, University of North
Carolina at Chapel Hill
74
• Rebecca Stebbins, University of North
Carolina at Chapel Hill
• Richard Wilson, Orange County
Information Technology
75
Appendix E: Community Health Assessment Survey Volunteers
76
1. Adair Smith
2. Anna Kenion
3. Asela Gillis-Alonso
4. Ashley DeSena
5. Barbara Pringle
6. Bono Sen
7. Camille Birkhead
8. Cathy Ferniany
9. Cathy York
10. Christine Rheem
11. Christy Bridges
12. Coby Jansen-Austin
13. Cynthia Bucy
14. Darlene Wirag
15. Deanna Bucy
16. Deanna Ryder
17. Donna King
18. Emily Earnest
19. Gary Barker
20. Hardik Patel
21. Irene Ferguson
22. Ishaan Pilant
23. Janaki Nicastro
24. Jean McDonald
25. Jennifer Sharpe
26. Jessica Salemo
27. Jessica Southwell
28. Jessica Young
29. Jirreney Colbert
30. Judy Butler
31. Jurate Sorensen
32. Kathleen Goodhand
33. Kendra Ferrell
34. Kristin Voltzke
35. Latitia Chavious
36. LaTosha Scott
37. LaToya Strange
38. Lela Nelson
39. Lindsey Urena
40. Lynn Hecht
41. Marne Meredith
42. Martha Workman
43. Matt Simon
44. Melissa Chua
45. Melissa Walter
46. Meredith McMonigle
47. Meredith Stewart
48. Michelle Robinson
49. Myra Austin
50. Pam McCall
51. Pat Casper
52. Patty Rhodes
53. Paula Craige
54. Rabiga Khozhamkul
55. Rebecca Crawford
56. Rhea Colmer
57. Ritza Saenz
58. Rongrong Qu
59. Samatha Croffut
60. Shelley Hoekstra
61. Steven Campbell
62. Susan Clifford
63. Susan Wagoner
64. Susan Ward
65. Tanika Reddon
66. Victoria Alonso
67. Xiaoming Gao
68. Teresa Martin
Appendix F: Map of Survey Locations
Appendix G: Notification Postcard Sent to Randomly Selected
Households
Appendix H: 2015 Orange County Community Health Opinion Survey,
English
2015 Orange County Community Health Opinion Survey
Date COMMENTS
Description ADMIN ONLY
Follow Up?
Phone Number:
____________________________
Address:
____________________________
____________________________
Email:
____________________________
€ No One Home
€ Language Barrier
Spanish
Other: ____________________
(Call back to complete? Provide phone
number)
€ Ended Before Survey Completed
(Call back to complete? Provide phone
number)
€ No one in home eligible
Under 18 years of age
Non-resident of Orange County
€ Household Refusal
€ Unoccupied/Vacant/Demolished House
€ Selected Address Not a Household
€ Survey Completed
Yes
No
2015 Orange County Community Health Opinion Survey
READ THE FOLLOWING SECTION TO EACH POTENTIAL PARTICIPANT:
Hello, I am _______ and this is ________ representing the Orange County Health
Department [SHOW BADGES]. We are conducting a survey of our community to
learn more about the health and quality of life in Orange County. Your response
will help determine the direction of future programs for the health department
and other agencies across the county. Maybe you remember a postcard that you
should have gotten in the mail recently that described the survey [SHOW
LAMINATED POSTCARD].
Your address was one of many randomly selected from our county. The survey is
completely voluntary, and it should take about 30 minutes to complete. There is
no right or wrong answer. You may refuse to answer any question. Your answers
will be completely confidential. The information you give us will not be linked to
you in any way.
NON-ENGLISH LANGUAGE RESPONDENTS ONLY
IF RESPONDENT IS SPANISH-SPEAKING ONLY
SHOW RESPONDENT THE MESSAGE BELOW ON LAMINATED SHEET AND OFFER A PEN TO WRITE DOWN
THEIR PHONE NUMBER BELOW.
We are conducting a community health survey. You may have received a postcard about this in the mail.
Unfortunately, we do not have a Spanish-speaking interviewer available at this time, but if you would
like to participate in the survey, please write your telephone number below and we can have a Spanish-
speaking interviewer call you later. Thank you for understanding.
Phone Number: ______________________
Estamos realizando una encuesta de la salud de la comunidad. Usted puede haber recibido una carta al
respecto en el correo. Desafortunadamente en este momento no tenemos disponible a un entrevistador
que hable español, pero si usted desea participar de la encuesta, por favor, escriba su número de
teléfono aquí abajo y un entrevistador que hable español puede llamarle más tarde. Gracias por su
comprensión.
Número de teléfono: ______________________
IF RESPONDENT DOES NOT SPEAK ENGLISH OR SPANISH
GIVE RESPONDENT A COPY OF THE POSTCARD IN ENGLISH. IF YOU CAN, ASK THEIR LANGUAGE AND
RECORD BELOW.
Language: ________________________
READ THE FOLLOWING TO RESPONDENT AND OFFER A PEN TO WRITE DOWN THEIR PHONE NUMBER.
We are conducting a community health survey. We are sorry that we do not have interviewers available
today who speaks that language. If you would like someone to call you later, please write your phone
number below.
Phone Number: _________________
Would you be willing to participate? YES NO
(If NO, stop the survey here and thank him/her for his/her time.)
ELIGIBILITY
Do you live in Orange County? YES NO
(If NO, stop the survey here and thank him/her for his/her time.)
I will now begin asking questions. If you realize that you have already participated in this survey
this year, let me know, and I can stop.
BEGIN SURVEY
Community Improvement
Read: These first set of questions will ask about community problems, issues, and services
that are important to you based on the topics selected for Healthy North Carolina 2020. In
these questions, and all the ones that follow, there is no right or wrong answer. We are
just interested in your honest opinion, based on what you have seen or experienced.
Remember your choices will not be linked to you in any way.
1. All topics are important; choose the one(s) most important to you (select all that
apply).
€ Tobacco Use
€ Physical Activity & Nutrition
€ Injury & Violence
€ Maternal & Infant Health
€ Sexually Transmitted Disease &
Unintended Pregnancy
€ Substance Abuse
€ Mental Health
€ Oral Health
€ Environmental Health
€ Infectious Disease & Foodborne Illness
€ Social Determinants of Health
(poverty, housing, homelessness,
graduation rates, unemployment,
uninsured)
€ Chronic Disease
€ Cross-Cutting (life expectancy, years
lost, single parent households)
2. If you had to pick one issue, from the previous list, which would it be?
€ 1- Tobacco Use
€ 2- Physical Activity & Nutrition
€ 3- Injury & Violence
€ 4- Maternal & Infant Health
€ 5- Sexually Transmitted Disease &
Unintended Pregnancy
€ 6- Substance Abuse
€ 7- Mental Health
€ 8- Oral Health
€ 9- Environmental Health
€ 10- Infectious Disease & Foodborne
Illness
€ 11- Social Determinants of Health
(poverty, housing, homelessness,
graduation rates, unemployment,
uninsured)
€ 12- Chronic Disease
€ 13- Cross-Cutting (life expectancy,
years lost, single parent households)
Health Information
3. Where do you get most of your health-related information? (Choose only one.)
€ Friends and Family
€ Doctor/Nurse
€ Pharmacist
€ Church
€ Internet
€ My Child’s School
€ Hospital
€ Health Department
€ Help Lines
€ Books/Magazines
€ Don’t Know/Not Sure
€ Other _____________
€ Refused to Answer
4. In your opinion, what are the top three programs/services/issues for teens that
should be a priority in this community? (Choose only three)
€ Dental hygiene
€ Nutrition
€ Eating Disorders
€ Asthma management
€ Diabetes management
€ Tobacco including e-cigarettes
€ Sexually Transmitted Diseases (STDs)
€ Sex education
€ Alcohol
€ Drug Abuse
€ Reckless driving/speeding
€ Mental health issues
€ Suicide prevention
€ Other ________________
€ Refused to Answer
Personal Health
5. Would you say that, in general, your health is…(Choose only one)
€ Excellent
€ Very good
€ Good
€ Fair
€ Poor
€ Don’t know/Not sure
€ Refused to Answer
6. Have you ever been told by a doctor, nurse, or other health professional that you have any of
the health conditions? (DK= Don’t know/ Not sure; R= Refuse to answer)
a. Asthma € Yes € No € DK € R
b. Depression or anxiety € Yes € No € DK € R
c. High Blood Pressure € Yes € No € DK € R
d. High Cholesterol € Yes € No € DK € R
e. Diabetes (not during
pregnancy)
€ Yes € No € DK € R
f. Osteoporosis € Yes € No € DK € R
g. Overweight/Obesity € Yes € No € DK € R
h. Heart Disease € Yes € No € DK € R
i. Cancer € Yes € No € DK € R
7. Do you identify as Male or Female, or another way?
€ Male
€ Another Way
€ Female
€ Refused to Answer
8. When it comes to Cancer screenings, have you ever had a…..(DK= Don’t know/ Not sure; R=
Refuse to answer, NA = Not Applicable/Does not apply)
Mammogram (Female)? – An
x-ray taken only of the breast
by a machine that presses
against the breast.
€ Yes € No € DK € R € NA
PSA or DRE test (Male)? – The
prostate-specific antigen (PSA)
test and digital rectal exam
(DRE) are tests used to check
men for prostate cancer.
€ Yes € No € DK € R € NA
Blood Stool Test
(Male/Female)? – A test that
may use a special kit at home
to determine whether the stool
contains blood.
€ Yes € No € DK € R € NA
9. In the past 30 days, have there been any days when feeling sad or worried kept you from
going about your normal business?
€ Yes
€ Don’t Know/Not Sure
€ No
€ Refused to Answer
10. During a normal week, other than in your regular job, how many days do you engage in
any physical activity or exercise for at least a half an hour?
€ Zero (0) days
€ One to two (1-2) days
€ Three to four (3-4) days
€ Five (5) or more days
€ Refused to Answer
11. If you answered “zero days”, what are the reasons you do not exercise for at least half an
hour for 3 or more days during a normal week? (Choose all that apply.)
€ N/A: I answered more than zero (0) days
€ I don’t have time.
€ It costs too much.
€ I don’t have convenient exercise
facilities.
€ I don’t have child care.
€ There is no safe place to exercise.
€ I have no one to exercise with.
€ My job is physical or hard labor.
€ I don’t like to exercise.
€ I’m too tired to exercise.
€ I’m physically disabled.
€ Exercise is not important to me.
€ Don’t know/Not sure
€ Other _____________________
€ Refused to Answer
12. Where do you go to exercise or engage in physical activity? (Check all that apply.)
€ Gym or Recreation Center
€ Public Parks or Trails
€ Home
€ Work
€ Church
€ School
€ Daily Travel/Commute (i.e.
walking/biking to work/school)
€ Other: ______________________
€ Refused to Answer
13. Not counting lettuce salad or potato products, how many servings per week of fruits and
vegetables would you say you eat?
€ Five (5) or more cups
€ Three to four (3-4) cups
€ Two (2) or fewer cups
€ Never eat fruits/vegetables
€ Don’t know/Not sure
€ Refused to Answer
14. In the past month, did you ever cut the size of your meals, or skip meals, because there
wasn’t enough money for food?
€ Yes
€ Refused to Answer
€ No
15. During the past 12 months, have you had a seasonal flu vaccine?
€ Yes, flu shot
€ Yes, flu spray
€ Yes, both
€ No
€ Don’t Know/Not Sure
€ Refused to Answer
16. About how much do you weigh without shoes?
Weight: ______________ pounds
€ Refused to Answer
17. About how tall are you without shoes?
Height: ___________feet ___________ inches
€ Refused to Answer
NOTE: Body Mass Index (BMI) is a measure of body fat based on height and weight that applies to adult
men and women.
Environmental Health
18. Have you been exposed to secondhand smoke in the past year?
€ Yes
€ Don’t know/Not sure
€ No.
€ Refused to Answer
19. If yes, where do you think you are exposed to secondhand smoke most often? (Check all
that apply)
€ N/A; I am not exposed to
secondhand smoke
€ Home
€ Work
€ Hospitals
€ Restaurants
€ School
€ Bars/Nightclubs
€ Coffee Shops
€ Public Places
€ Other: ___________________
€ Refused to Answer
20. Do you currently smoke or use tobacco products, whether regularly or in social settings?
(Products such as e-cigarettes, hookah, etc.)
€ Yes
€ Refused to Answer
€ No
21. If yes, where would you go for help first if you wanted to quit? (Choose only one.)
€ N/A; I don’t want to quit
€ Quit Line NC
€ Doctor
€ Church/Minister
€ Pharmacy
€ Private Counselor/Therapist
€ Health Department
€ Don’t know/Not sure
€ Other: ___________________
€ Refused to Answer
Access to Care
22. Where do you go most often when you are sick? (Choose only one.)
€ Doctor’s Office
€ Hospital Emergency Room
€ Hospital Clinic
€ Urgent Care
€ Health Department
€ Piedmont Health Services
€ Other: ________________
€ Refused to Answer
23. What is your primary health insurance plan? This is the plan which pays the medical bills
first or pays most of the medical bills? (Please choose only one.)
€ No health plan of any kind
€ The State Employee Health Plan
€ Blue Cross and Blue Shield of North
Carolina
€ Other private health insurance
plan purchased from employer or
workplace
€ Other private health insurance
plan purchased directly from an
insurance company
€ Medicare
€ Medicaid or Carolina ACCESS or
Health Choice 55
€ The military, Tricare, CHAMPUS,
or the VA
€ The Indian Health Service
€ Other (government plan)
€ Don't know/Not sure
€ Refused to Answer
24. Do you have children under the age of 19 for whom you are the caretaker? (Includes step-
children, grandchildren, or other relatives).
€ Yes
€ Refused to Answer
€ No
25. Have you ever had trouble getting medical care for the child(ren) you care for?
€ Yes
€ Refused to Answer
€ No
€ Not Applicable; Does not apply
26. If “yes”, why did you have trouble? (Choose all that apply)
€ N/A; Does not apply
€ There are no doctors in my community
€ My children don’t have health insurance or
medical coverage
€ I couldn’t afford it
€ The doctors don’t accept Medicaid
€ The doctors have strict late or “no-show”
policies that make it difficult to stay with
the practice
€ It’s too hard to get to a doctor’s
office
€ The hours and days they are
open is not convenient
€ Other: ____________________
€ Refused to Answer
27. In the past 12 months, did you have a problem getting the health care you needed for you
personally or for a family member from any type of health care provider, dentist, pharmacy,
or other facility?
€ Yes
€ Don’t Know/Not Sure
€ No
€ Refused to Answer
28. If you said “yes,” what type of provider or facility did you or your family member have
trouble getting health care from? (Choose all that apply).
€ N/A; Does not apply
€ Dentist
€ General practitioner
€ Eye care/ optometrist/
ophthalmologist
€ Pharmacy/ prescriptions
€ Pediatrician
€ OB/GYN
€ Health department
€ Hospital
€ Urgent Care Center
€ Medical Clinic
€ Specialist:________________
€ Refused to Answer
29. Concerning your issue of access, which of these problems prevented you or your family
member(s) from getting the necessary health care? (Choose all that apply).
€ N/A; Does not apply
€ No health insurance
€ Insurance didn’t cover what I/we
needed
€ My/our share of the cost
(deductible/co-pay) was too high
€ Doctor would not take my/our
insurance or Medicaid
€ Hospital would not take my/our
insurance
€ No transportation get there
€ Dentist would not take my/our
insurance or Medicaid
€ Pharmacy would not take my/our
insurance or Medicaid
€ Didn’t know where to go
€ Couldn’t get an appointment
€ The wait was too long
€ Other: ____________________
€ Refused to Answer
30. If a friend or family member needed counseling for a mental health or a drug/alcohol
abuse problem, who would you tell them to talk to? (Choose all that apply).
€ Private counselor or therapist
€ Support group (e.g., AA. Al-Anon)
€ School counselor
€ Minister/religious official
€ Doctor
€ Don’t know/Not Sure
€ Other: _____________________
€ Refused to Answer
Emergency Preparedness
31. Does your household have working smoke and carbon monoxide detectors? (Choose only
one.)
€ Yes, smoke detectors only
€ Yes, carbon monoxide detectors only
€ Yes, both
€ No
€ Don’t know/ Not sure
€ Refused to Answer
32. What would be your main way of getting information from authorities in a large-scale
disaster or emergency? (Check only one.)
€ Television
€ Radio
€ Internet
€ Print media (ex: newspaper)
€ Social networking site
€ Neighbors
€ Text message (emergency alert
system)
€ Other: ______________________
€ Don’t know/ Not sure
€ Refused to Answer
Demographic Questions
33. How old are you? ____________
34. What is your race? (Please check all that apply.)
€ White
€ Black or African American
€ American Indian or Alaska Native
€ South Asian, including Asian Indian,
Sri Lankan, Pakistani, Nepalese, etc.
€ Other Asian including Japanese,
Chinese, Korean, Vietnamese, and
Filipino/a
€ Pacific Islander including Native
Hawaiian, Samoan,
Guamanian/Chamorro
€ Hispanic/Latino
€ Other: _____________________
€ Refused to Answer
35. Do you speak a language other than English at home?
€ Yes
€ Refused to answer
€ No
€ If yes, what language do you speak at
home? _________________________
36. What is your marital status?
€ Never Married/Single
€ Married
€ Divorced
€ Other
€ Widowed
€ Separated
€ Unmarried partner
€ Refused to answer
37. What is the highest level of school, college or vocational training that you have finished?
(Choose only one.)
€ Less than 9th grade
€ 9-12th grade, no diploma
€ High school graduate (or GED/
equivalent)
€ Associate’s Degree or Vocational
Training
€ Some college (no degree)
€ Bachelor’s degree
€ Graduate or professional degree
€ Other: ________________________
€ Refused to answer
38. What was your total household income last year, before taxes? Let me know which
category you fall into. (Choose only one.)
€ Less than $10,000
€ $10,000 to $14,999
€ $15,000 to $24,999
€ $25,000 to $34,999
€ $35,000 to $49,999
€ $50,000 to $74,999
€ $75,000 to $99,999
€ $100,000 or more
€ Refused to answer
39. How many people does this income support? (If you are paying child support but your child
is not living with you, this still counts as someone living on your income.)_________
40. What is your employment status? (Choose all that apply.)
€ Employed full-time
€ Employed part-time
€ Retired
€ Armed forces
€ Unemployed for more than 1 year
€ Unemployed for 1 year or less
€ Disabled
€ Student
€ Homemaker
€ Self-employed
€ Refused to answer
41. Do you have access to the Internet?
€ Yes
€ No
€ Refused to Answer
42. What ways do you access the internet? (Choose all that apply)
€ Computer
€ Tablet
€ Watch
€ Smart Phone
€ Refused to Answer
Thank you for your time answering these questions about health. The Orange County Health
Department and Healthy Carolinians of Orange County will use the results of this survey to help address
the major health and community issues in our county. After these results are ready, we will host
community workshops, which you are invited to, to prioritize and decide on the most important county
issues.
43. Would you like to be additionally contacted by email or phone when this happens?
€ Yes
€ Don’t Know/Not Sure
€ No
€ Refused to Answer
Appendix I: 2015 Orange County Community Health Opinion Survey,
Spanish
2015 Orange County Community Health Opinion Survey
SPANISH VERSION / VERSIÓN EN ESPAÑOL
Date COMMENTS
Description ADMIN ONLY
Follow Up?
Phone Number
____________________________
Address:
____________________________
____________________________
Email:
____________________________
€ No One Home
€ Language Barrier
Spanish
Other: ____________________
(Call back to complete? Provide phone
number)
€ Ended Before Survey Completed
(Call back to complete? Provide phone
number)
€ No one in home eligible
Under 18 years of age
Non-resident of Orange County
€ Household Refusal
€ Unoccupied/Vacant/Demolished House
€ Selected Address Not a Household
€ Survey Completed
Yes
No
Encuesta de opinión sobre la salud de
la comunidad en el condado de Orange - 2015
READ THE FOLLOWING SECTION TO EACH POTENTIAL PARTICIPANT:
Buenos días/Buenas tardes, me llamo _______ y me acompaña ________.
Representamos al Departamento de Salud del Condado de Orange.
[SHOW BADGES] Estamos haciendo una encuesta en nuestra comunidad para
conseguir más información sobre la salud y la calidad de vida en el Condado de
Orange. Sus respuestas ayudarán a determinar la dirección de los futuros
programas del Departamento de Salud y de otras agencias a través de todo el
condado. Quizás recuerde haber recibido recientemente en el correo, una carta
que habla sobre esta encuesta. [SHOW LAMINATED POSTCARD].
El suyo es uno de los domicilios que se eligieron al azar en el condado. La encuesta
es totalmente voluntaria y tardaremos unos 30 minutos en completarla. No hay
respuestas correctas o incorrectas. Sus respuestas serán totalmente
confidenciales. La información que nos dé no será relacionada con usted por
ningún motivo.
NON-ENGLISH LANGUAGE RESPONDENTS ONLY
IF RESPONDENT IS SPANISH-SPEAKING ONLY
SHOW RESPONDENT THE MESSAGE BELOW ON LAMINATED SHEET AND OFFER A PEN TO WRITE DOWN
THEIR PHONE NUMBER BELOW.
We are conducting a community health survey. You may have received a postcard about this in the mail.
Unfortunately, we do not have a Spanish-speaking Interviewer available at this time, but if you would like
to participate in the survey, please write your telephone number below and we can have a Spanish-
speaking Interviewer call you later. Thank you for understanding.
Phone Number: _______________________________
Estamos realizando una encuesta de la salud de la comunidad. Usted puede
haber recibido una carta al respecto en el correo. Desafortunadamente en este
momento no tenemos disponible a un entrevistador que hable español, pero si
desea participar en la encuesta, por favor, escriba su número de teléfono aquí
abajo y un entrevistador que hable español puede llamarle más tarde. Gracias
por su comprensión.
Número de teléfono: ______________________
IF RESPONDENT DOES NOT SPEAK ENGLISH OR SPANISH
GIVE RESPONDENT A COPY OF THE POSTCARD IN ENGLISH. IF YOU CAN, ASK THEIR LANGUAGE AND
RECORD BELOW.
Language: __________________________________
READ THE FOLLOWING TO RESPONDENT AND OFFER A PEN TO WRITE DOWN THEIR PHONE NUMBER.
We are conducting a community health survey. We are sorry that we do not have interviewers available
today who speaks that language. If you would like someone to call you later, please write your phone
number below.
Phone Number: _____________________
¿Desea participar? SÍ NO
(If NO, stop the survey here and thank him/her for his/her time.)
ELIGIBILITY
¿Vive usted en el Condado de Orange? SÍ NO
(If NO, stop the survey here and thank him/her for his/her time.)
Ahora voy a empezar a hacer las preguntas. Si nota que usted ya ha participado este año en esta
encuesta, dígamelo, y puedo detenerme.
BEGIN SURVEY
Mejoras en la Comunidad
Read: Estas primeras preguntas son sobre los problemas, asuntos y servicios en la comunidad que
son importantes para usted en base a los temas seleccionados por Healthy North Carolina 2020. Para
estas preguntas, al igual que para todas las preguntas a continuación, no hay respuestas correctas o
incorrectas. Solo estamos interesados en conocer su honesta opinión, en base a sus vivencias y
experiencias. Recuerde que la información que nos dé nunca será relacionada con usted por ningún
motivo.
1. Todos los temas son importantes; elija los que son más importantes para usted
(Seleccione tantos como desee).
€ Uso de Tabaco
€ Nutrición y Actividad Física
€ Violencia y Lesiones
€ Salud Maternal e Infantil
€ Enfermedades de Transmisión Sexual y
Embarazo no Planeado
€ Abuso de Substancias
€ Salud Mental
€ Salud Oral
€ Salud Ambiental
€ Enfermedades Infecciosas y
Enfermedades Transmitidas por
Alimentos
€ Determinantes Sociales de la Salud
(pobreza, vivienda, falta de vivienda,
desempleo, tasas de graduación, falta
de seguro médico)
€ Enfermedades Crónicas
€ Temas-Transversales (esperanza de
vida, años perdidos, hogares con solo
uno de los padres)
2. Si tuviera que elegir solo uno de los anteriores temas, ¿Cuál elegiría?
€ 1- Uso de Tabaco
€ 2- Nutrición y Actividad Física
€ 3- Violencia y Lesiones
€ 4- Salud Maternal e Infantil
€ 5- Enfermedades de Transmisión
Sexual y Embarazo no Planeado
€ 6- Abuso de Substancias
€ 7- Salud Mental
€ 8- Salud Oral
€ 9- Salud Ambiental
€ 10- Enfermedades Infecciosas y
Enfermedades Transmitidas por
Alimentos
€ 11- Determinantes Sociales de la Salud
(pobreza, vivienda, falta de vivienda,
desempleo, tasas de graduación, falta
de seguro médico)
€ 12- Enfermedades Crónicas
€ 13- Temas-Transversales (esperanza
de vida, años perdidos, hogares con
solo uno de los padres)
Información sobre la Salud
3. ¿Dónde obtiene usted la mayoría de su información sobre la salud? (Elija solo uno.)
€ Amigos y Familiares
€ Médico/Enfermera
€ Farmacéutico
€ Iglesia
€ Internet
€ La escuela de su(s) hijo(s)
€ Hospital
€ El Departamento de Salud
€ Líneas telefónicas de ayuda
€ Libros/Revistas
€ No lo sabe o no está seguro
€ Otro _____________
€ No desea contestar
4. Según su opinión, ¿Cuáles son los tres principales programas o servicios para adolescentes
y jóvenes que deben ser una prioridad en esta comunidad? (Elija solo tres)
€ Higiene Dental
€ Nutrición
€ Enfermedades alimenticias
€ Control del asma
€ Control de la diabetes
€ Tabaco
€ Enfermedades de Transmisión Sexual
(ETS)
€ Educación Sexual
€ Alcohol
€ Abuso de drogas
€ Manejo desordenado/exceso de
velocidad
€ Problemas de salud mentales
€ Prevención de suicidio
€ Otro ________________
€ No desea contestar
Salud Personal
5. Diría usted que en general su salud es… (Elija solo uno)
€ Excelente
€ Muy Buena
€ Buena
€ Regular
€ Deficiente (Mala)
€ No lo sé/ No estoy seguro
€ No desea contestar
6. ¿Le ha dicho un médico, enfermera u otro profesional de la salud que usted tiene alguna de
estas condiciones de salud? (NS= No lo sabe o no está seguro; D= No desea contestar)
j. Asma € Sí € No € NS € D
k. Depresión o ansiedad € Sí € No € NS € D
l. Presión Alta € Sí € No € NS € D
m. Colesterol Alto € Sí € No € NS € D
n. Diabetes (no durante el
embarazo)
€ Sí € No € NS € D
o. Osteoporosis € Sí € No € NS € D
p. Sobrepeso /Obesidad € Sí € No € NS € D
q. Enfermedad del Corazón € Sí € No € NS € D
r. Cáncer € Sí € No € NS € D
7. ¿Usted se identifica como Hombre, Mujer o de alguna otra manera?
€ Hombre
€ De otra manera
€ Mujer
€ No desea contestar
8. En cuanto a exámenes de detección del cáncer, ¿Se ha realizado un o una… (NS= No lo sabe
o no está seguro; D= No desea contestar; NA= No aplica)
Mamografía (Mujeres)? – Una
radiografía solo de los senos en una
máquina que se presiona contra los
senos.
€ Sí € No € NS € D € NA
La prueba PSA o DRE (Hombres)? –
El examen de sangre del antígeno
prostático específico (PSA) y el
examen tacto rectal (DRE) - usados
para revisar por cáncer de la
próstata en los hombres.
€ Sí € No € NS € D € NA
Examen de sangre en las heces
(Hombres y Mujeres)? – Un
examen que puede usar un
paquete en casa para determinar si
hay sangre en las heces.
€ Sí € No € NS € D € NA
9. En los últimos 30 días, ¿Han habido días, en los que no ha podido hacer sus actividades
normales por sentirse triste o preocupado/a?
€ Sí
€ No lo sabe o no está seguro
€ No
€ No desea contestar
10. Ahora voy a preguntarle sobre su condición física. Durante una semana normal, además de
en su trabajo regular, ¿Cuántos días realiza alguna actividad física o ejercicio por al menos
media hora?
€ Ningún día (0)
€ De uno a dos días (1-2)
€ De tres a cuatro días (3-4)
€ Cinco días o más (5 o +)
€ No desea contestar
11. ¿A dónde va usted a hacer ejercicio o realizar una actividad física? (Marque todas las que
apliquen.)
€ Gimnasio o centro de recreación
€ Parques o senderos públicos
€ En su casa
€ En su trabajo
€ Iglesia
€ Escuela
€ Como parte de su desplazamiento
diario/yendo de un lugar a otro (por
ejemplo: va a su trabajo o escuela
caminando o montando bicicleta)
€ Otro: _______________________
€ No desea contestar
12. ¿Si contestó "cero días", cuáles son los motivos por los que no hace ejercicio al menos
media hora 3 o más días en una semana normal? (Elija todas las que apliquen.)
€ No tiene tiempo.
€ Cuesta mucho dinero.
€ No tiene instalaciones para ejercicios
que sean convenientes para usted.
€ No tiene cuidado para los niños.
€ No hay un lugar que sea seguro para
hacer ejercicio.
€ No tiene con quien hacer ejercicio.
€ Su trabajo es físico o implica labor física.
€ No le gusta el ejercicio.
€ Está muy cansado para hacer
ejercicio.
€ Tiene un impedimento o
discapacidad física que se lo impide.
€ El ejercicio no es importante para
usted.
€ No lo sabe o no está seguro
€ Otro _____________________
€ No desea contestar
13. Sin contar la lechuga, la ensalada o los productos con papa, ¿Cuántas servidas de frutas y
vegetales piensa que come por semana?
€ Cinco (5) o más tazas
€ Tres o cuatro (3-4) tazas
€ Dos (2) o menos tazas
€ Nunca come frutas o vegetales
€ No lo sabe o no está seguro
€ No desea contestar
14. El mes pasado, ¿Alguna vez comió menos o dejó de comer porque no tenía suficiente dinero
para obtener alimentos?
€ Sí
€ No desea contestar
€ No
15. Ahora voy a preguntar sobre su vacuna contra la gripe o influenza. En los últimos 12 meses,
¿Le han puesto la vacuna contra la gripe estacional?
€ Sí, la vacuna inyectable contra la
gripe
€ Sí, la vacuna en atomizador nasal
€ Sí, ambas
€ No
€ No lo sabe o no está seguro
€ No desea contestar
Cálculo del BMI (Índice de Masa Corporal) – El Índice de Masa Corporal (BMI) es una manera de medir
la grasa corporal basada en el peso y altura, y se aplica tanto a hombre y mujer.
16. ¿Cómo cuánto pesa usted sin zapatos?
Weight (peso): ______________ pounds (en libras)
€ No desea contestar
17. ¿Cómo cuánto mide usted sin zapatos?
Height (altura): ___________feet (pies) ___________ inches (pulgadas)
€ No desea contestar
Salud del Medio Ambiente
18. ¿En el pasado año, ha estado expuesto al humo de segunda mano?
€ Sí
€ No lo sabe o no está seguro
€ No.
€ No desea contestar
19. Si contestó sí, ¿Dónde piensa que está expuesto al humo de segunda mano con más
frecuencia? (Marque todas las que apliquen)
€ Hogar
€ Trabajo
€ Hospitales
€ Restaurantes
€ Escuela
€ Bares y Clubes Nocturnos
€ Cafeterías/ Cafés
€ Lugares Públicos
€ Otro: ___________________
€ No Aplica; No estoy expuesto al
humo de cigarro de segunda mano
€ No desea contestar
20. ¿Actualmente fuma o usa productos de tabaco, ya sea regularmente o en entornos sociales?
(Productos como cigarrillos electrónicos, cachimba/hookah, etc.)
€ Sí
€ No desea contestar
€ No
21. Si contestó sí, ¿Cuál sería el primer lugar a donde iría a buscar ayuda si quisiera dejar de
fumar o consumir productos de tabaco? (Elija solo uno.)
€ Línea telefónica (Quit Line NC)
€ Doctor
€ Iglesia/Ministro religioso
€ Farmacia
€ Consejero o Terapista Privado
€ Departamento de Salud
€ No lo sabe o no está seguro
€ Otro
€ Esta pregunta no aplica
€ No desea contestar
Acceso a la Atención de Salud
22. ¿A dónde acude con más frecuencia cuando se enferma? (Elija solo uno.)
€ Consultorio Médico
€ Sala o Cuarto de Emergencia del
Hospital
€ Clínica del Hospital
€ Clínica de Cuidados de Urgencia
€ Departamento de Salud
€ Centro de Salud Comunitario
Piedmont Health Services (Ejemplo: La
Clínica de Carrboro o de Prospect Hill)
€ Otro: ________________
€ No desea contestar
23. ¿Cuál es su principal seguro médico o plan de salud? ¿Es este el seguro o plan que paga las
facturas médicas primero o paga la mayor parte de las facturas médicas? (Por favor elija
solo uno.)
€ No tiene ningún plan de salud
€ Plan de Salud de Empleados del Estado
€ Blue Cross y Blue Shield de Carolina del
Norte
€ Otro plan de seguro médico privado
adquirido a través de su empleador o
lugar de trabajo
€ Otro plan de seguro médico privado
adquirido directamente de una
compañía de seguros
€ Medicare
€ Medicaid o Carolina ACCESS o
Health Choice 55
€ Plan para personal militar,
Tricare, CHAMPUS, o VA
€ Indian Health Service
€ Otro (plan del gobierno)
€ No lo sabe o no está seguro
€ No desea contestar
24. ¿Tiene niños menores de 19 años que dependen de usted? (Incluyendo hijastros, nietos u
otros familiares).
€ Sí
€ No desea contestar
€ No
25. ¿Ha tenido alguna vez problemas para obtener atención médica para los menores que
dependen de usted?
€ Sí
€ No desea contestar
€ No
€ Esta pregunta no aplica
26. Si contestó “Sí”, por qué tuvo problemas? (Elija todas las que apliquen)
€ No hay médicos en su comunidad
€ Sus niños no tienen seguro de salud o
cobertura médica
€ No podía pagar por la atención médica
€ Los médicos no aceptan Medicaid
€ Los médicos tienen reglas estrictas sobre
llegar tarde o “faltar a las citas” que hacen
difícil poder continuar con estos médicos
€ Es muy/demasiado difícil llegar a
un consultorio médico
€ Las horas y los días en que están
abiertos no son convenientes
€ Otro: ____________________
€ Esta pregunta no aplica
€ No desea contestar
27. En los últimos 12 meses, ¿Tuvo problemas para obtener la atención médica que necesitó para
usted o para un miembro de la familia de cualquier tipo de proveedor médico, dentista,
farmacia u otro centro?
€ Sí
€ No lo sabe o no está seguro
€ No
€ No desea contestar
28. Si contestó “Sí,” ¿De cuál tipo de proveedor o centro, usted o el miembro de su familia, tuvo
dificultad para obtener cuidados de salud? (Elija todas las que apliquen).
€ Dentista
€ Médico General
€ Cuidado de la vista/ optómetra/
oftalmólogo
€ Farmacia/ prescripciones o recetas
€ Pediatra
€ Obstetra o ginecóloga
€ Departamento de Salud
€ Hospital
€ Centro de Cuidados de Urgencia
€ Clínica Médica
€ Especialista:________________
€ Esta pregunta no aplica
€ No desea contestar
29. Con respecto al problema de acceso, ¿Cuáles de estos problemas impidieron que usted o
algún miembro o miembros de su familia recibieran los cuidados de salud necesarios? (Elija
todas las que apliquen).
€ No tenía seguro médico o de salud
€ El seguro no cubría lo que usted o su
familia necesitaba
€ La parte del costo que tenía que pagar
(deducible/copago) era muy alto
€ El médico no aceptaba su seguro o
Medicaid
€ El hospital no aceptaba su seguro
médico
€ No tenía forma de llegar al médico
€ El dentista no aceptaba su seguro o
Medicaid
€ La farmacia no aceptaba su seguro o
Medicaid
€ No sabía a dónde ir
€ No pudo conseguir una cita
€ La espera fue demasiado larga
€ Otro: ____________________
€ Esta pregunta no aplica
€ No desea contestar
30. ¿Si un amigo o miembro de la familia necesitara consejería para la salud mental o un
problema de abuso de drogas o alcohol, con quién les diría que hable? (Elija todas las que
apliquen).
€ Consejero o terapista privado
€ Grupo de apoyo (ejemplo: AA. Al-
Anon)
€ Consejero de la escuela
€ Ministro u oficial religioso
€ Médico
€ No lo sé/No estoy seguro
€ Otro: _____________________
€ No desea contestar
Preparación para Casos de Emergencia
31. ¿Tiene su casa detectores de humo y detectores de monóxido de carbono que funcionen?
(Elija solo uno.)
€ Sí, solo detectores de humo
€ Sí, solo detectores de monóxido de
carbono
€ Sí, ambos
€ No
€ No lo sabe o no está seguro
€ No desea contestar
32. ¿Cuál sería su principal forma de obtener información de las autoridades en caso de una
emergencia o catástrofe de gran escala? (Elija solo uno.)
€ Televisión
€ Radio
€ Internet
€ Prensa escrita (ejemplo: periódico)
€ Sitios de internet (redes) sociales
€ Vecinos
€ Mensajes de texto (sistema de alerta de
emergencias)
€ Otro:____________________________
€ No lo sabe o no está seguro
€ No desea contestar
Preguntas Demográficas
33. ¿Cuántos años tiene? ___________
34. ¿De qué raza es usted? (Por favor marque todas las que apliquen.)
€ Blanco
€ Negro o afro-americano
€ Nativo americano o nativo de Alaska
€ del sur de Asia, incluyendo Indo-
asiático, Esrilanqués, Pakistaní,
Nepalés, etc.
€ Otro Asiático incluyendo Japonés,
Chino, Coreano, Vietnamita, y
Filipino
€ de las Islas del Pacífico incluyendo
Nativo Hawaiano, Samoano,
Guames/Chamorro
€ Hispano/Latino
€ Otro: _____________________
€ No desea contestar
35. ¿Habla en casa algún otro idioma además de inglés?
€ Sí
€ No desea contestar
€ No
€ Si contestó Sí, ¿Qué otro idioma habla en
casa? _________________________
36. ¿Cuál es su estado civil?
€ Nunca se ha casado/soltero
€ Casado
€ Divorciado
€ Otro
€ Viudo
€ Separado
€ Vive con su pareja pero no están casados
€ No desea contestar
37. ¿Cuál es el más alto nivel de educación escolar, universitario o entrenamiento vocacional
que ha completado? (Elija solo uno.)
€ Menos del noveno (9th) grado
€ Entre el 9 al 12 grado, sin haber
obtenido un diploma
€ Obtuvo diploma del 12avo grado
(High School) o equivalente (GED)
€ Diploma de 2 años de Universidad,
College o capacitación vocacional
€ Estudios Universitarios o de College
(sin haber obtenido un diploma)
€ Título universitario, Licenciatura
€ Título de Postgrado o Professional
€ Otro: ________________________
€ No desea contestar
38. ¿Cuál fue el ingreso total de su familia el año pasado, antes de sacar los impuestos? Dígame
en cuál de estas categorías estaría. (Elija solo una.)
€ Menos de $10,000
€ $10,000 to $14,999
€ $15,000 to $24,999
€ $25,000 to $34,999
€ $35,000 to $49,999
€ $50,000 to $74,999
€ $75,000 to $99,999
€ $100,000 o más
€ No desea contester
39. ¿Cuántas personas dependen de este ingreso? (Si está pagando manutención para niños pero
su niño no vive con usted, esto aún cuenta como alguien viviendo de su ingreso.)_________
40. ¿Cuál es su situación laboral? (Elija todas las que apliquen.)
€ Empleado a tiempo completo
€ Empleado a medio tiempo
€ Retirado/Jubilado
€ En las Fuerzas Armadas/Militar
€ Desempleado por más de 1 año
€ Desempleado por menos de 1 año
€ No puede trabajar debido a una
enfermedad o incapacidad
€ Estudiando
€ Hace las labores del hogar en casa
€ Trabajando por su cuenta
€ No desea contestar
41. ¿Tiene acceso a Internet?
€ Sí
€ No
€ No desea contestar
42. ¿De qué formas tiene acceso al internet? (Elija todas las que apliquen)
€ Computadora
€ Tableta (Tablet)
€ Reloj
€ Teléfono celular (Smart Phone)
€ No desea contestar
Gracias por su tiempo respondiendo estas preguntas acerca de la salud. El Departamento de Salud del
Condado de Orange y Healthy Carolinians del Condado de Orange utilizarán los resultados de esta
encuesta para ayudar a determinar cómo abordar los principales asuntos sobre la salud y la
comunidad en nuestro condado. Una vez estén listos los resultados, realizaremos talleres
comunitarios, a los cuales usted está invitado, para priorizar y decidir sobre los asuntos más
importantes en el condado.
43. ¿Desea ser contactado adicionalmente, ya sea por email o por teléfono, cuando esto
suceda?
€ Sí
€ No
€ No desea contestar
Appendix J: Focus Group Guide and Demographics, English
Orange County Community Health Assessment
Focus Group Discussion Guide
INTRODUCTION
Thank you for taking the time to join us today.
INTRODUCE YOURSELF, NOTETAKER(S)
THE FOLLOWING SCRIPT IS FOR YOU TO SUMMARIZE. YOU DO NOT NEED TO READ IT WORD
FOR WORD. YOU DO NEED TO COVER CONFIDENTIALITY AND THE RIGHT TO WITHDRAW
WITHOUT PENALTY.
I am working with the Orange County Health Department and Healthy Carolinians of Orange County,
and we are interested in learning about the health of Orange County residents. Today we would like to
hear what you think about the overall health of your community (i.e. physical, mental, and
environmental). The information that you share, information gathered from community surveys, other
discussions and existing statistics, will help us plan future programs that better meet the needs of
residents of Orange County.
No names will be attached to any of the information we collect. We will share what we learn with
community and agency members during open forums in the fall. In the winter we will write a report
about our county’s health, to submit to the state. If you would like to be invited to a community forum,
please write your name and contact information on the sign-up sheet. (INCLUDED WITH
DEMOGRAPHICS SHEET)
While we talk today, I want you to feel free to share your opinions even if they are different from others
and to react to each other's thoughts. There is no right or wrong answer. I am here to help facilitate the
discussion and listen to what you have to say. (NOTETAKER’S NAME) _________ will be taking notes. If
there are no objections, we will be recording this discussion to make sure we do not miss any
comments. Try and speak up so the recorder can pick up your answer. After this discussion, we will
listen to the recording and write down all of the responses, and then we will erase/destroy the
recording. Since this is a group discussion, you do not have to wait for me to call on you to speak.
Anything we say here is confidential. I ask that when you all leave today that you remember to respect
others' privacy and not share any information outside of this discussion. We will talk for about 1 hour.
You are here because you voluntarily agree to participate in this group discussion. However, if for any
reason you feel uncomfortable and do not want to continue in the discussion, you are free to withdraw
at any time. This will not affect, in any way, the services you receive in the future from Orange County.
Again, no names will be attached to the information that we collect. Is this OK with everyone?
(DO NOT CONTINUE UNTIL EVERYONE AGREES OR DISMISSES THEMSELVES. ONCE YOU ARE READY TO
BEGIN, TURN ON THE RECORDER).
OPENING
Let us start with introductions. One at a time, please introduce yourself and tell us how long you have
lived in Orange County.
INTRODUCTORY QUESTIONS
1. Since we will be talking about health, what does being healthy mean to you, personally?
PROBE: Think about physical health. Mental health. Environmental health.
2. Another way to think about health is looking at the health of a community, not just individuals.
To you, what would a healthy community look like?
PROBE: In a perfect world, how would you describe a perfect community?
o Built Environment (sidewalks, crosswalks, bike lanes, etc.)
o Safety
o Access
o Transportation/travel time
o Housing
o Employment
o Schools
o Recreation activities
o Religion
o Healthcare
TRANSITION QUESTIONS
3. What do you think are the healthiest things about your physical community/Orange County?
:PROBE: parks/trails, recreation facilities, numerous medical facilities, farmer’s markets?
4. Now, thinking about less healthy things, which things concern you the most about the health of
your physical community/Orange County?
PROBE: Thinking about where you live, are their health issues that specifically concern
you?
o Tobacco use
o Drug use
o Violent crime
o Alcohol
o Low graduation rates
o Lack of access to things such as: health care, grocery stores
o Farmer’s market
KEY QUESTIONS
THE MOST TIME PROBING SHOULD BE SPENT ON THESE QUESTIONS. FOLLOW ANSWERS WITH PHRASES
LIKE, “TELL ME MORE ABOUT…” OR “COULD YOU GIVE ME AN EXAMPLE…” OR “IN WHAT WAYS…”
5. Thinking about the people in your community, what are your main health concerns?
PROBE: physical, mental, environmental
6. Where do you go for health care services?
PROBE: The hospital, clinic, health department, other (cultural healers).What are the reasons for
going/not going to those facilities?
7. Tell us about your own experience getting the help you need in Orange County.
PROBE: Positive experiences, challenges/barriers
8. Are there groups of people within your community whose healthcare needs seem to be
overlooked, or not met?
PROBE: Who? Older adults, men, women, people who live in rural areas, etc. In what ways? Why
do you think that might be?
9. Where do you and others in your community get most of your health information?
PROBE: TV, radio, internet? Experience or comfort level with technology?
10. In your neighborhoods/communities, is biking/walking to school encouraged or supported?
PROBE: Is it safe for students to walk/bike to school?
i. Are their bike lanes?
ii. Are schools close enough for students to bike/walk to school?
iii. Do you live by or off of major highways where biking/walking is not safe?
iv. Would you feel comfortable and safety for your students if they biked or walked to
school alone?
11. Think back over all the topics we’ve discussed. If you were in charge, what specific things would you do
to improve the health status of community members?
PROBE: What specific things do you wish that agencies were doing to help you and your
community? Are there things you would do to improve people’s access to care, health
information, quality of care, subsidies/cost, types of services available?
ENDING QUESTIONS
12. We want to make sure that the health programs in this community will help you and your
community. With that in mind, is there anything that we have not asked or that you would like to
add?
13. Do you have any questions about the community health assessment process?
CLOSING
14. Questions from the notetaker(s)?
Thank you!! **INCENTIVE FOR PARTICIPATION**
Demographic Information
Questions will only be reported as a summary of all answers given by focus group participants. Your
individual answers will remain anonymous.
Demographic Questions
1. How old are you? ____________
2. What is your race? (Please check all that apply.)
€ White
€ Black or African American
€ American Indian or Alaska Native
€ South Asian, including Asian Indian,
Sri Lankan, Pakistani, Nepalese, etc.
€ Other Asian including Japanese,
Chinese, Korean, Vietnamese, and
Filipino/a
€ Pacific Islander including Native
Hawaiian, Samoan,
Guamanian/Chamorro
€ Hispanic/Latino
€ Other: _____________________
€ Refused to Answer
3. Do you speak a language other than English at home?
€ Yes
€ Refused to answer
€ No
€ If yes, what language do you speak at
home? _________________________
4. What is your marital status?
€ Never Married/Single
€ Married
€ Divorced
€ Other
€ Widowed
€ Separated
€ Unmarried partner
€ Refused to answer
5. What is the highest level of school, college or vocational training that you have finished?
(Choose only one.)
€ Less than 9th grade
€ 9-12th grade, no diploma
€ High school graduate (or GED/
equivalent)
€ Associate’s Degree or Vocational
Training
€ Some college (no degree)
€ Bachelor’s degree
€ Graduate or professional degree
€ Other: ________________________
€ Refused to answer
6. What was your total household income last year, before taxes? Let me know which category
you fall into. (Choose only one.)
€ Less than $10,000
€ $10,000 to $14,999
€ $15,000 to $24,999
€ $25,000 to $34,999
€ $35,000 to $49,999
€ $50,000 to $74,999
€ $75,000 to $99,999
€ $100,000 or more
€ Refused to answer
7. How many people does this income support? (If you are paying child support but your child is
not living with you, this still counts as someone living on your income.)_________
8. What is your employment status? (Choose all that apply.)
€ Employed full-time
€ Employed part-time
€ Retired
€ Armed forces
€ Unemployed for more than 1 year
€ Unemployed for 1 year or less
€ Disabled
€ Student
€ Homemaker
€ Self-employed
€ Refused to answer
9. Do you have access to the Internet?
€ Yes
€ No
€ Refused to Answer
10. What ways do you access the internet? (Choose all that apply)
€ Computer
€ Tablet
€ Watch
€ Smart Phone
€ Refused to Answer
11. What is your zip code? ___________________
Community Forum/Presentations
If you would like to be sent an invitation to the Community Forums/presentations in the Fall
where we will present the data collected and begin prioritizing issues, please provide your name
and contact information.
This information will be kept separate from the above questions/answers.
Name
Email Address
Mailing Address
Street Address:
City: State: Zip Code
Appendix K: Focus Group Guide and Demographics, Spanish
Evaluación de Salud de la Comunidad del Condado de Orange
Guía de Discusión del Grupo de Enfoque
INTRODUCCIÓN
Gracias por tomarse el tiempo para reunirse con nosotros hoy.
PRESÉNTESE USTED Y A LAS PERSONAS QUE ESTÉN TOMADO NOTAS Y GRABANDO
EL SIGUIENTE ESCRITO ES PARA QUE LO RESUMA. NO ES NECESARIO LEERLO PALABRA POR
PALABRA. NECESITA HABLAR SOBRE LA CONFIDENCIALIDAD Y EL DERECHO A RETIRARSE SIN
SUFRIR CONSECUENCIAS.
Estoy trabajando con el Departamento de Salud del Condado de Orange y Healthy Carolinians del
Condado de Orange - y estamos interesados en aprender sobre la salud de los residentes del Condado
Orange. Hoy nos gustaría saber qué piensan acerca de la salud de su comunidad en general (por ejemplo
física, mental y ambiental). La información que ustedes compartan, junto con información obtenida de
las encuestas comunitarias, otros diálogos y las estadísticas existentes, nos ayudará a planear futuros
programas que satisfagan mejor las necesidades de los residentes del Condado de Orange.
Ningún nombre será conectado con ninguna de la información que obtengamos. Compartiremos lo que
aprendamos con miembros de comunidad y de la agencia durante foros abiertos en el otoño. En el
invierno escribiremos un informe acerca de la salud de nuestro condado, para enviarlo al estado. Si
desea ser invitado a un foro comunitario, por favor escriba su nombre y la información para ponerse en
contacto con usted en la hoja de asistencia. (INCLUIDA CON LA HOJA DE INFORMACIÓN DEMOGRÁFICA)
Mientras hablamos, quiero que se sienta libre para compartir sus opiniones, incluso si son diferentes de
las de los demás, y a responder a los pensamientos de otros. No hay respuestas correctas o incorrectas.
Estoy aquí para ayudar a facilitar la discusión y escuchar lo que tienen que decir. (NOMBRE DE QUIEN
ESTÁ TOMANDO NOTAS) _________ va a tomar notas. Si no hay objeciones, vamos a grabar esta
discusión para asegurarnos de no perder ningún comentario. Trate de hablar de forma que la grabadora
pueda recoger su respuesta. Después de esta discusión, vamos a escuchar la grabación y escribir todas
las respuestas, luego vamos a borrar o destruir la grabación. Como se trata de una discusión de grupo,
no tiene que esperar que yo se lo indique para hablar. Todo lo que digamos aquí es confidencial. Les
pido que cuando se retiren, recuerden respetar la privacidad de los demás y no compartir ninguna de la
información fuera de esta discusión. Vamos a hablar por cerca de una hora.
Ustedes están aquí porque voluntariamente aceptaron participar en esta discusión en grupo. Sin
embargo, si por alguna razón se siente incómodo y no desea continuar en la discusión, usted es libre de
retirarse en cualquier momento. Esto no afectará de ningún modo los servicios que reciba en el futuro
del Condado de Orange. Una vez más, ningún nombre será conectado a la información que obtengamos.
¿Están todos de acuerdo?
(NO CONTINÚE HASTA QUE TODOS ESTÉN DE ACUERDO O SE RETIRE EL QUE NO ESTÉ DE ACUERDO.
CUANDO ESTÉ LISTO ENCIENDA LA GRABADORA.)
PREGUNTAS PRELIMINARES
Comencemos con las presentaciones. Uno a la vez, por favor, preséntese y díganos cuánto tiempo ha
vivido en el Condado de Orange.
PREGUNTAS DE INTRODUCCIÓN
1. Como vamos a hablar acerca de la salud, para usted, personalmente ¿qué significa, ser
saludable?
EXPLORACIÓN: Piense sobre salud física. Salud mental. Salud ambiental.
2. Otra manera de pensar acerca de la salud es mirando la salud de la comunidad, no solo a los
individuos. Para usted, ¿Cómo se vería una comunidad saludable?
• EXPLORACIÓN: En un mundo perfecto, ¿cómo describiría una comunidad perfecta? Medio
ambiente construido (aceras, pasos peatonales, carriles para bicicletas, etc.)
• Seguridad
• Acceso
• Transporte/tiempo del viaje
• Vivienda
• Empleo
• Escuelas
• Actividades recreativas
• Religión
• Cuidado de salud
PREGUNTAS DE TRANSICIÓN
3. Para usted, ¿cuáles son las cosas más saludables acerca de su comunidad física/el Condado de
Orange?
EXPLORACIÓN: parques/senderos, lugares de recreación, numerosos instalaciones médicas y
mercados de agricultores/(farmer’s markets).
4. Ahora, pensando en cosas menos saludables, ¿Cuáles cosas le preocupan más acerca de la salud
de su comunidad física/del Condado de Orange?
• EXPLORACIÓN: Piense a cerca de donde vive, ¿hay asuntos de salud que le preocupen
específicamente? Uso de tabaco
• Uso de drogas
• Crimen violento
• Alcohol
• Baja tasa de graduación
• Falta de acceso a cosas tale como: cuidados de salud, tiendas de comestibles
• Mercados de agricultores
PREGUNTAS CLAVES
LA MAYORÍA DEL TIEMPO DE LA DISCUSIÓN DEBE SER USADO EN ESTAS PREGUNTAS. SIGA LAS
RESPUESTAS CON FRASES COMO: “DÍGAME MÁS ACERCA DE…” O “PODRÍA DARME UN EJEMPLO…” O
“DE QUE MANERAS…”
5. Pensando en las personas en su comunidad, ¿cuáles son sus principales preocupaciones acerca de
la salud?
EXPLORACIÓN: física, médica, dental, mental, nutricional, ambiental, seguro médico
6. ¿A dónde va para sus servicios de salud?
EXPLORACIÓN: El hospital, una clínica, el departamento de salud, otro (curanderos o
otros sanadores típicos de su cultura). ¿Cuáles son las razones por las que va o no va a esas
instalaciones?
7. Díganos sobre su propia experiencia para conseguir la ayuda que necesita en el Condado de Orange.
EXPLORACIÓN: Las experiencias positivas, los desafíos/obstáculos
EXPLORACIÓN SI TIENE TIEMPO: ¿Qué hace que valga la pena su tiempo y esfuerzo para ir a una
cita? (AYUDA) ¿Qué le impide ir a una cita? (BARRERA)
8. Díganos sobre su experiencia comunicándose con su proveedor de salud.
EXPLORACIÓN: ¿Cuándo está en una cita, su proveedor de salud se comunica bien con
usted? ¿Puede comunicarle sus necesidades e ideas a su proveedor de salud? Dígame
más al respecto.
9. ¿Hay grupos de personas dentro de su comunidad cuyas necesidades de salud parecen haberse
pasado por alto o no haber sido satisfechas?
EXPLORACIÓN: ¿Quién? Adultos mayores, hombres, mujeres, personas que viven en áreas
rurales, etc. ¿De qué manera? ¿Por qué piensa que sucede eso?
10. ¿Dónde obtiene usted y otros en su comunidad la mayoría de su información de salud?
EXPLORACIÓN: ¿La televisión, la radio, el Internet? ¿Experiencia o nivel de comodidad con la
tecnología?
11. ¿En sus barrios o comunidades se anima o apoya el ir a la escuela en bicicleta o caminando?
EXPLORACIÓN: ¿Es seguro para los estudiantes caminar o ir en bicicleta a la escuela?
• ¿Hay carriles para bicicleta?
• ¿Están las escuelas lo suficientemente cerca para que los estudiantes vayan en bicicleta
o caminando?
• ¿Vive en o cerca de carreteras principales donde no es seguro caminar o andar en
bicicleta?
• ¿Siente que es cómodo y hay seguridad para sus estudiantes si van en bicicleta o
caminando solos a la escuela?
12. Piense sobre todos los temas que hemos discutido. Si estuviera a cargo, ¿Qué cosas específicas haría para
mejorar el estado de salud de los miembros de la comunidad?
EXPLORACIÓN: ¿Qué cosas concretas desea que las agencias hagan para ayudarle a usted y a su
comunidad? ¿Hay cosas que usted haría para mejorar el acceso a la atención de salud, la
información de salud, la calidad de la atención, las subvenciones/costo, los tipos de servicios
disponibles?
PREGUNTAS FINALES
13. Queremos estar seguros de que los programas de salud en esta comunidad le ayudarán a usted y a
su comunidad. Con eso en mente, ¿Hay algo que no hemos preguntado o que le gustaría añadir?
14. ¿Tiene alguna pregunta sobre el proceso de la evaluación comunitaria?
CONCLUSIÓN
15. ¿Hay preguntas de la(s) persona(s) que están tomando nota?
¡¡Gracias!! **INCENTIVOS POR PARTICIPAR**
PIDA QUE COMPLETEN LAS HOJAS DE INFORMACIÓN DEMOGRÁFICA Y LAS COSAS DE LA RIFA
Información Demográfica
Las preguntas solo serán reportadas como un resumen de todas las respuestas recibidas de los participantes
del grupo de enfoque. Sus respuestas permanecerán anónimas.
1. ¿Cuántos años tiene? (Marque la categoría que corresponde a su edad.)
€ 18-24
€ 25-34
€ 35-44
€ 45-54
€ 55-64
€ 65-74
€ 75 o mayor
2. ¿Usted se identifica como Hombre o Mujer, o de otra manera?
€ Hombre
€ De otra manera
€ Mujer
3. ¿De qué raza es usted? (Por favor marque todas las que apliquen.)
€ Blanco
€ Negro o Afro-Americano
€ Nativo Americano o Nativo de Alaska
€ Del sur de Asia, incluyendo Indo-
asiático, Esrilanqués, Pakistaní,
Nepalés, etc.
€ Otro Asiático incluyendo Japonés,
Chino, Coreano, Vietnamita, y
Filipino
€ De las islas del Pacífico incluyendo
Nativo Hawaiano, Samoano,
Guames/Chamorro
€ Hispano/Latino
€ Otro: _____________________
4. ¿Habla en casa algún otro idioma además de inglés?
€ Sí
€ No
€ Sí contestó sí, ¿qué idioma habla en casa?
_________________________
5. ¿Cuál es su estado civil?
€ Nunca se ha casado/Soltero
€ Casado
€ Divorciado
€ Otro
€ Viudo
€ Separado
€ Vive con su pareja pero no están casados
6. ¿Cuál es el más alto nivel de educación escolar, universitario o de entrenamiento vocacional
que usted completó? (Elija solo uno.)
€ Menos del noveno (9no) grado
€ Grados del 9 al 12avo, sin haber
obtenido un diploma
€ Terminó 12 años de educación y
obtuvo un diploma (o GED/
equivalente)
€ Diploma universitario de dos años o
Capacitación Vocacional
€ Estudios universitarios o de College
sin haber obtenido un diploma
€ Título universitario/Licenciatura
€ Título de postgrado o Profesional
€ Otro: ________________________
7. ¿Cuál fue el ingreso total de su familia el año pasado, antes de sacar los impuestos? Indique
en que categoría está usted. (Elija solo una.)
€ Menos de $10,000
€ $10,000 a $14,999
€ $15,000 a $24,999
€ $25,000 a $34,999
€ $35,000 a $49,999
€ $50,000 a $74,999
€ $75,000 a $99,999
€ $100,000 o más
€ No desea contestar
8. ¿Cuántas personas dependen de este ingreso? (Sí está pagando manutención para niños pero
su niño o niña no vive con usted, aun así cuenta como alguien viviendo de su
ingreso.)_________
9. ¿Cuál es su situación laboral? Voy a leer una lista de opciones. Dígame cuales aplican a usted.
(Elija todas las que apliquen.)
€ Empleado a tiempo completo
€ Empleado a tiempo parcial/ medio
tiempo
€ Retirado/ Jubilado
€ En las Fuerzas Armadas / Militar
€ Desempleado por más de un año
€ Desempleado por menos de un año
€ Incapacitado
€ Estudiante
€ Hace las labores del hogar en casa
€ Trabaja por cuenta propia
10. ¿Tiene acceso al Internet?
€ Si
€ No Sabe/No Está Seguro
€ No
11. ¿De qué maneras tiene acceso al Internet? (Elija todas las que apliquen)
€ Computadora de Alta Velocidad
€ Tabletas
€ Reloj
€ Teléfono Celular (Smart Phone)
12. ¿Cuál es su Código Postal (zip code)? ___________________
Foro de la Comunidad/Presentaciones
Sí desea que le envíen una invitación para el Foro Comunitario/ La presentación en el otoño donde
vamos a presentar los resultados y a empezar a dar un orden de prioridad a los asuntos, por favor denos
su nombre y la información para contactarle.
Esta información se mantendrá separada de las preguntas y respuestas anteriores.
Nombre
Dirección de Correo
Electrónico
Dirección Postal
Dirección:
Ciudad: Estado: Código Postal
Appendix L: Youth Focus Group Guide and Demographic
Orange County Community Health Assessment
Focus Group Discussion Guide
INTRODUCTION
Thank you for taking the time to join us today.
INTRODUCE YOURSELF, NOTETAKER(S)
THE FOLLOWING SCRIPT IS FOR YOU TO SUMMARIZE. YOU DO NOT NEED TO READ IT WORD
FOR WORD. YOU DO NEED TO COVER CONFIDENTIALITY AND THE RIGHT TO WITHDRAW
WITHOUT PENALTY.
I am working with the Orange County Health Department and Healthy Carolinians of Orange
County, and we are interested in learning about the health of Orange County residents. Today
we would like to hear what you think about the overall health of your community (i.e. physical,
mental, and environmental). The information that you share, information gathered from
community surveys, other discussions and existing statistics, will help us plan future programs
that better meet the needs of residents of Orange County.
No names will be attached to any of the information we collect. We will share what we learn
with community and agency members during open forums in the fall. In the winter we will
write a report about our county’s health, to submit to the state. If you would like to be invited
to a community forum, please write your name and contact information on the sign-up sheet.
(INCLUDED WITH DEMOGRAPHICS SHEET)
While we talk today, I want you to feel free to share your opinions even if they are different
from others and to react to each other's thoughts. There is no right or wrong answer. I am here
to help facilitate the discussion and listen to what you have to say. (NOTETAKER’S NAME)
_________ will be taking notes. If there are no objections, we will be recording this discussion
to make sure we do not miss any comments. Try and speak up so the recorder can pick up your
answer. After this discussion, we will listen to the recording and write down all of the
responses, and then we will erase/destroy the recording. Since this is a group discussion, you
do not have to wait for me to call on you to speak. Anything we say here is confidential. I ask
that when you all leave today that you remember to respect others' privacy and not share any
information outside of this discussion. We will talk for about 1 hour.
You are here because you voluntarily agree to participate in this group discussion. However, if
for any reason you feel uncomfortable and do not want to continue in the discussion, you are
free to withdraw at any time. This will not affect, in any way, the services you receive in the
future from Orange County. Again, no names will be attached to the information that we
collect. Is this OK with everyone?
(DO NOT CONTINUE UNTIL EVERYONE AGREES OR DISMISSES THEMSELVES. ONCE YOU ARE
READY TO BEGIN, TURN ON THE RECORDER).
OPENING
Let us start with introductions. One at a time, please introduce yourself and tell us what you like most
about living in Orange County.
INTRODUCTORY QUESTIONS
15. Since we will be talking about health, what does being healthy mean to you, personally?
PROBE: Think about physical health. Mental health. Environmental health.
16. What type of things makes Orange County healthy?
PROBE: parks/trails, recreation facilities, plenty of medical facilities, farmer’s markets?
17. Now, thinking about less healthy things, which things concern you the most about the health of
Orange County?
PROBE: Thinking about where you live, are their health issues that specifically concern
you?
o Tobacco use
o Drug use
o Crime
o Alcohol
o Low graduation rates
o Suicide
TRANSITION QUESTIONS
18. Do you see a lot of “unhealthy behavior” among people your age?
PROBE: Things like unsafe sexual activities, drug use, bullying, skipping school, suicide, etc.
19. Among those things, what do people your age engage in the most?
PROBE: Is there one thing that is more common than others? (I.e. tobacco use, drinking,
prescription drug sharing, sexual activities, etc.)
KEY QUESTIONS
THE MOST TIME PROBING SHOULD BE SPENT ON THESE QUESTIONS. FOLLOW ANSWERS WITH PHRASES
LIKE, “TELL ME MORE ABOUT…” OR “COULD YOU GIVE ME AN EXAMPLE…” OR “IN WHAT WAYS…”
20. Where do people your age get drugs?
PROBE: Alcohol, marijuana, prescription drugs, tobacco (chewing, cigarettes)?
21. How easy is it for people your age to get drugs from those places that you just mentioned?
PROBE: Do they get it from people in school, from parents or adults, from other students/peers?
22. What makes people your age want to do drugs, of any kind?
PROBE: Peer pressure, family members doing it, stress, boredom, etc.?
23. What are some of the things that can happen to people your age if they use drugs?
PROBE: Think about things like overdose, alcohol poison, car wrecks, hospital visits.
24. How do parents, and other adults in your community, feel about people your age drinking and
doing other drugs?
PROBE: Do they know, and if so, what do they do to try and stop it?
Do they talk to you about it?
Do they not care if you are at home with them?
25. Do people your age care about the health of the community?
PROBE: Do people your age engage in clubs or educate their peers to help prevent things like
smoking, drinking, or using drugs to improve health?
26. Are people your age physically active?
PROBE: What type of activities do they engage in? Are they mainly traditional school sports or
do people your age engage in activities that are not the traditional sports?
27. If biking/walking to school was the norm, would you choose to bike and/or walk to school?
PROBE: Would you prefer to bike or walk versus riding the bus or getting dropped off?
Would your parents let you?
Would you feel safe to bike/walk alone or would you prefer to have an adult or parent
with you?
28. Think back over all the topics we’ve discussed. If you were in charge, what specific things would you do
to improve the health of your community?
PROBE: What specific things do you wish that agencies were doing to help you and your
community? Are there things you would do to improve people’s access to care, health
information, quality of care, subsidies/cost, types of services available?
ENDING QUESTIONS
29. Is there anything that we have not asked or that you would like to add?
30. Do you have any questions about the community health assessment process?
CLOSING
31. Questions from the note taker(s)?
Thank you!! **INCENTIVE FOR PARTICIPATION**
Healthy Carolinians of Orange County
Youth Survey and Focus Group Questions
We want to know a few things about you, your thoughts and opinions. All responses are completely
confidential, so please be honest when answering.
1. I go to…
Carrboro High School ...................................................................................................................... 11
Chapel Hill High School ................................................................................................................... 22
East Chapel Hill High School ............................................................................................................ 33
2. I am a…
Freshman ......................................................................................................................................... 11
Sophomore ...................................................................................................................................... 22
Junior ............................................................................................................................................... 33
Senior .............................................................................................................................................. 44
3. I am…
Male ................................................................................................................................................ 11
Female ............................................................................................................................................. 22
4. I am…
13 ..................................................................................................................................................... 22
14 ..................................................................................................................................................... 33
15 ..................................................................................................................................................... 44
16 ..................................................................................................................................................... 55
17 ..................................................................................................................................................... 66
18 or older ....................................................................................................................................... 77
5. I am… (Select all that apply.)
American Indian or Alaska Native .................................................................................................. 11
Asian ............................................................................................................................................... 11
Black or African American .............................................................................................................. 11
Hispanic or Latino ........................................................................................................................... 11
Native Hawaiian or other Pacific Islander ...................................................................................... 11
White .............................................................................................................................................. 11
6. My parent(s) talk to me about…
Never Seldom Sometimes Frequently Always
a. Staying away from alcohol ................................11 22 33 44 55
b. Staying away from tobacco (including
cigarettes, chewing tobacco, e-cigarettes,
hookah, etc.) ................................................................11 22 33 44 55
c. Staying away from prescription drugs that
are not prescribed to me ................................................................11 22 33 44 55
Never Seldom Sometimes Frequently Always
d. Staying away from other harmful drugs (i.e.
marijuana, heroin, etc.)…………….. 11 22 33 44 55
e. Abstinence and/or safe sex…………….. 11 22 33 44 55
7. How much trouble would a student get into if they were caught with…
Not at All Not Much Some A lot
a. Alcohol at school or at a school event? ................................................................11 22 33 44
b. A prescription drug not prescribed to them at school or a
school event? ................................................................................................11 22 33 44
c. Tobacco products at school or at a school event?..... 11 22 33 44
d. Any harmful drug or substance at school or at a school
event?.................................
Thank you for completing this survey.
We really appreciate your help.
Appendix M: Community Listening Session Flyers, English and Spanish
Listening Session Dates
1 Rogers Road Community Center
Date: Saturday, October 3
Time: 1:00p – 3:00p
Address: 101 Edgar Street. Chapel Hill, 27516
2 Frank Porter Graham Elementary
Date: Monday, October 5
Time: 6:00p – 8:00p
Address: 101 Smith Level Rd. Chapel Hill, 27516
3 Mt. Zion AME Church
Date: Tuesday, October 6
Time: 4:00p – 6:00p
Address: 5124 NC Hwy 86 N. Hillsborough, 27278
4 UNC Hospital – Hillsborough Campus
Date: Tuesday, October 20
Time: 4:00p – 6:00p
Address: 430 Waterstone Dr. Hillsborough, 27278
5 Efland-Cheeks Community Center
Date: Thursday, October 22
Time: 6:00p – 8:00p
Address: 117 Richmond Road. Efland, 27302
Are you interested in improving
the health of our community?
Join us for a Community Listening
Session to share your thoughts.
FREE DINNER SERVED!
Compliance with the “Americans with Disabilities Act”
and Title VI - Interpreter services and/or special sound
equipment are available on request. Call the Immigrant and
Refugee Health Program Manager at 919.245.2387 to
request an interpreter or other accommodation.
Conforme a la “Ley sobre Estadounidenses con
Discapacidades” (ADA) y el Título VI – los servicios de
intérprete y/o equipo de sonido especial están disponibles
a solicitud. Llame a la Administradora del Programa de
Salud para Inmigrantes y Refugiados al 919-245-2387
para solicitar un intérprete u otros arreglos o adaptaciones.
Together we will:
Learn about what was found in conversations
with neighbors during the 2015 Community
Health Assessment.
Discuss your concerns with people who work in
government and the health department.
Help decide what health issues are the most
important for the Healthy Carolinians of Orange
County Partnership.
Map out next steps toward a plan that improves
the health of the whole community.
201 5 Orange County Com munity Health Assessment
Community Listening Sessions
To attend a Community Listening Session e -mail hcoc@orangecountync.gov or call 919.245.2440
Fechas de las Reuniones
Centro Comunitario Rogers Road
Fecha: Sábado, 3 de octubre
Hora: de 1:00pm a 3:00pm
Dirección: 101 Edgar Street. Chapel Hill, 27516
Primaria de Frank Porter Graham
Fecha: Lunes, 5 de octubre
Hora: de 6:00pm a 8:00pm
Dirección: 101 Smith Level Rd. Chapel Hill, 27516
Iglesia AME Mt. Zion
Fecha: Martes, 6 de octubre
Hora: de 4:00pm a 6:00pm
Dirección: 5124 NC Hwy 86 N. Hillsborough, 27278
Hospital UNC – ubicado en Hillsborough
Fecha: Martes, 20 de octubre
Hora: de 4:00pm a 6:00pm
Dirección: 430 Waterstone Dr. Hillsborough, 27278
Centro Comunitario Efland-Cheeks
Fecha: Jueves, 22 de octubre
Hora: de 6:00pm a 8:00pm
Dirección: 117 Richmond Road. Efland, NC 27302
¿Le interesa mejorar la salud de
su comunidad?
Venga a una de las Reuniones para Escuchar a la
Comunidad y comparta sus ideas y pensamientos.
¡HABRÁ CENA GRATIS!
Compliance with the “Americans with Disabilities Act” and
Title VI - Interpreter services and/or special sound equipment are
available on request. Call the Immigrant and Refugee Health
Program Manager at 919.245.2387 to request an interpreter or
other accommodation.
Conforme a la “Ley sobre Estadounidenses con
Discapacidades” (ADA) y el Título VI – los servicios de
intérprete y/o equipo de sonido especial están disponibles a
solicitud. Llame a la Administradora del Programa de Salud para
Inmigrantes y Refugiados al 919-245-2387 para solicitar un
intérprete u otros arreglos o adaptaciones.
Lo que haremos juntos:
Aprender sobre lo que descubrimos en las
conversaciones con los vecinos durante la
Evaluación de Salud en la Comunidad del 2015.
Hablar sobre sus preocupaciones con personas
que trabajan en el gobierno y en el Departamento
de Salud.
Ayudar a decidir cuáles temas de salud son los
más importantes para la Alianza Healthy
Carolinians del Condado de Orange
Crear los pasos siguientes hacia un plan para
mejorar la salud de toda la comunidad
Evaluación de Salud de la Comunidad en el Condado de Orange (2015)
Reuniones para Escuchar a la Comunidad
Para mayor información, envíe un correo electrónico a hcoc@orangecountync.gov o llame al 919.245.2440
Appendix N: References:
1U.S. Census Bureau (2015). State and County Quick Facts. Retrieved from http://quickfacts.census.gov/qfd/states/37/37135.html
2 North Carolina Department of Commerce. (2015). AccessNC County Profile. North Carolina Economic Data and Site Information. Retrieved from
http://accessnc.commerce.state.nc.us/docs/countyProfile/NC/37135.pdf.
3 http://www.census.gov/quickfacts/table/PST045215/3710620,3711800,3731620
4 U.S. Census Bureau (2015). State and County Quick Facts. Retrieved from http://quickfacts.census.gov/qfd/states/37/37135.html.
5 http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF
6 US Census Bureau (2010). Detailed Hispanic or Latino Origin, and Asian Population. Retrieved from
http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none.
7 Orange County Health Department (2005-2015). Refugee Screening Logs.
8 American Community Survey (2010-2014). 5-Year Estimates. Retrieved from http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none.
9 Orange County NC Genealogy (2010). Orange County, NCGenWeb. Retrieved from http://ncgenweb.us/nc/orange/.
10 Felitti et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive
Medicine. Retrieved from http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract.
11 Child Trends report “Adverse Childhood Experiences: National and State-Level Prevalence” Retrieved from http://www.childtrends.org/wp-
content/uploads/2014/07/Brief-adverse-childhood-experiences_FINAL.pdf.
12 Austin and Herrick (2014). The Effect of Adverse Childhood Experiences on Adult Health: 2012 North Carolina Behavioral Risk Factor Surveillance System. Retrieved
from http://www.schs.state.nc.us/schs/pdf/SCHS_Study_167_FIN_20140505.pdf.
13 U.S. Department of Health and Human Services. (2016). Healthy People 2020: Access to Health Services. Retrieved from
http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
14 North Carolina State Center for Health Statistics (2012). CHAMP Racial and Ethnic Disparities in Child Health. Retrieved from
http://www.schs.state.nc.us/schs/pdf/CHAMP_FS_RAED_20120615.pdf
15 NC Resident Population. Health Data by Race and Ethnicity 2010-2014. Retrieved from
http://www.schs.state.nc.us/schs/pdf/NCPopHealthDatabyRaceEthNov2015.pdf
16 Orange County (2015). Community Health Assessment Focus Group Results, Latino Immigrants and Refugees from Burma.
17 U.S. Census Bureau (2014). American Fact Finder. Selected Economic Characteristics 2010 – 2014 American Community Survey 5 – Year Estimates. Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_5YR_DP03&prodType=table
18 U.S. Department of Health and Human Services (2016). The Affordable Care Act. Retrieved from: http://www.hhs.gov/healthcare/about-the-law/read-the-
law/index.html#
19 American Academy of Periodontology (2015). Gum Disease and Heart Disease. Accessed from: https://www.perio.org/consumer/heart_disease
20 U.S. Census Bureau (2014). American Fact Finder. Selected Economic Characteristics 2010-2014 American Community Survey 5-Year Estimates. Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_5YR_DP03&prodType=table
21 U.S. Department of Health and Human Services. (2000). Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving
Health. Washington, DC: U.S. Government Printing Office.
22 Orange County Literacy Council (2016). Retrieved from http://orangeliteracy.org/why-literacy/
23 Centers for Disease Control and Prevention (2013). Emergency Department Visits by Patients with Mental Health Disorders – North Carolina, 2008 – 2010.
Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6223a4.htm
24 NC Department of Health and Human Services (2015). Injury and Violence Prevention Branch. Suicide Prevention. Retrieved from
http://www.injuryfreenc.ncdhhs.gov/preventionResources/Suicide.htm
25 UNC School of Medicine (2015). Alcoholism and Alcohol Abuse. Retrieved from https://www.med.unc.edu/alcohol/education-prevention/alcoholism-and-alcohol-
abuse/alcoholism.
26 North Carolina Alcohol Facts (2013). Crashes that Involved Alcohol, 2009-2013. Retrieved from (http://ncaf.hsrc.unc.edu/county_veh.cfm.
27 NC Department of Health and Human Services (2016). Unintentional Poisoning from Prescription Drugs (Overdose). Retrieved from
http://www.injuryfreenc.ncdhhs.gov/preventionResources/UnintentionalPoisoning.htm.
28 North Carolina Institute of Medicine Task Force on Prevention. (2009). Prevention for the Health of North Carolina: Prevention Action Plan. Morrisville, NC: North
Carolina Institute of Medicine.
29 Lasser, K., Boyd, W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and Mental illness: A population based prevalence study.
Journal of the American Medical Association, 284, 2606–2610.
30 U.S. Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism (2007). Alcohol and Tobacco. Alcohol Alert, 71.
http://pubs.niaaa.nih.gov/publications/AA71/AA71.htm.
31 Centers for Disease Control and Prevention. Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older. Retrieved from
http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html..
32 American Cancer Society. (2014). Cancer Facts & Figures 2014. Atlanta: American Cancer Society.
33 U.S. DHHS (2014). The Health Consequences of Smoking – 50 Years of Progress. A Report of the Surgeon General, Executive Summary.
34 Strasburger, V.C. & the Council on Communications and Media. (2010). Pediatrics: Children, Adolescences, Substance Abuse, and Media. Pediatrics. 126, 791-799.
35 U.S. DHHS (2014). The Health Consequences of Involuntary Exposure to Tobacco Smoke. A Report of the Surgeon General.
36 U.S. DHHS (2014). Smoking and Youth. Surgeon’s Report on Smoking and Health.
37 Preliminary data from Chapel Hill Carrboro School District YRBS (2015).
38 Singh T., et al. (2016). Vital signs: exposure to electronic cigarette advertising among middle school and high school students—United States, 2014. MMWR.
64(52):1403-8.
39 Federal Trade Commission. (2015). Federal Trade Commission Cigarette Report for 2012. Washington: Federal Trade Commission.
40 Thornburg, J. (2016). E-Cigarettes and Vapor Products: State of the Science. Presentation to Orange County Board of Health. Available at:
http://www.orangecountync.gov/departments/health
41 American Industrial Hygiene Association. (2014). White Paper: Electronic Cigarettes in the Indoor Environment. Falls Church, VA. Available at:
https://www.aiha.org/government-affairs/Documents/Electronc%20Cig%20Document_Final.pdf
42 CDC Office on Smoking and Health. (2015). Electronic Nicotine Delivery Systems: Key Facts. Available at:
http://www.cdc.gov/tobacco/stateandcommunity/pdfs/ends-key-facts2015.pdf
43 Thornburg, J. (2016). E-Cigarettes and Vapor Products: State of the Science. Presentation to Orange County Board of Health. Available at:
http://www.orangecountync.gov/departments/health
44 Thornburg, J., et. al. (2015). Exhaled Electronic Cigarette Emissions: What’s Your Secondhand Exposure? Research Triangle Park, NC. RTI Press. Available at:
https://www.rti.org/pubs/secondhand_exposure_to_electronic_cigarette_emissions.pdf
45 U.S. Department of Agriculture (2016).All About the Fruit Group. Retrieved from http://www.choosemyplate.gov/fruit.
46 NC State Center for Health Statistics (2016). 2016 County Health Book. 2010 – 2014 Race-Sex-Specific Age-Adjusted Death Rates by County.
http://www.schs.state.nc.us/data/databook/
47 NC State Center for Health Statistics (2016). 2016 County Health Book. Death County and Crude Death Rates per 100,000 Population for Leading Causes of Death,
by Age Groups NC 2010-2014. Retrieved from http://www.schs.state.nc.us/data/databook/
48 NC State Center for Health Statistics (2016). 2016 County Health Book. 2010 – 2014 Race-Sex-Specific Age-Adjusted Death Rates by County. Retrieved from
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49 NC Department of Health and Human Services (2015). Breast and Cervical Cancer Control Program. Cardiovascular Disease. Retrieved from
http://bcccp.ncdhhs.gov/cardiovascular.htm.
50 Heart Attack and Stroke Prevention Center (2012-2016). Risks of Living in the Stroke Belt. Retrieved from http://www.thepreventioncenter.com/cardiovascular-
disease/stroke-belt/.
51 NC Department of Health and Human Services (2015). Breast and Cervical Cancer Control Program. Cardiovascular Disease. Retrieved from
http://bcccp.ncdhhs.gov/cardiovascular.htm.
52 Medline Plus. Diabetes. Retrieved from http://www.nlm.nih.gov/medlineplus/diabetes.html.
53 U.S. Department of Health and Human Services. Global Health Topics. Communicable Diseases. Retrieved from http://www.globalhealth.gov/global-health-
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54 NC Department of Health and Human Services (2015). North Carolina HIV/STD Quarterly Surveillance Report: Vol. 2015, No. 4 HIV/STD Surveillance Unit. Retrieved
from http://epi.publichealth.nc.gov/cd/stds/figures/vol15no4.pdf.
55 NC Department of Health and Human Services (2014). HIV Infections in North Carolina Reported HIV Case Data, 2014. Retrieved from
http://epi.publichealth.nc.gov/cd/stds/figures/factsheet_HIV_infection_2014r3.pdf.
56 Orange County Economic Development (2016). Orange County Community Profile. Retrieved from http://growinorangenc.com/livability/community-profile/
57 Campaign for Racial Equity in Our Schools (2015). Excellence with Equity: The Schools Our Children Deserve. Retrieved from
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59 UNC School of Government (2013). Hunger Research: Understand Food Insecurity in Your Community. Retrieved from http://hunger-
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3/14/2016
1
March 23, 2016
Community Health Assessment Update
Phase 8:Develop the Community Health Action Plans
Phase 7:Disseminate CHA Document to the Community
Phase 6:Create Community Health Assessment Document
Phase 5:Solicit Community Input to Select Health Priorities
Phase 4: Combine and Analyze Primary and Secondary Data
Phase 3: Collect and Analyze Community Health Statistics
Phase 2: Collect Community Data
Phase 1: Establish Community Assessment Team
CHA Process Accomplishments
Data Collection
Quantitative: Survey Collection
1,714 total responses (1,548 online surveys and 166 door-to-door)
Qualitative:
5 Focus Groups -(57 voices)
4 Community Listening Sessions (76 voices)
Secondary
County level data updated in the form of dashboards
Prioritization
Occurred in December at HCOC’s Annual Meeting
Document Writing and Submission
Electronically submitted –3/10/16
Hard copy mailed –3/14/16
Chosen Community Priorities
Chosen Priorities for Action Planning:
1.Social Determinants of Health
Access
Poverty
2.Mental Health & Substance Abuse
3.Physical Activity & Nutrition
Chronic Disease Prevention
CHA Overview
3/14/2016
2
BOH Requirements for Accreditation
Benchmark 38: The local board of health shall participate
in the establishment of public health goals and objectives.
Activity 38.1 –the local board of health shall annually by
the LHD on the community’s health (e.g. SOTCH & CHA)
Required documentation:Minutes reflecting board of
health’s review of annual reports related to the
community’s health
BOH Requirements for Accreditation
Activity 38.2 –The local board of health shall review
community health assessment data and citizen input used
to plan and monitor progress toward health-related goals.
Documentation –Board of health minutes reflecting
discussion of specific aspects of CHA data AND the approval
of action plans to address health related goals.
BOH Requirements for Accreditation
Activity 38.3 –The local board of health shall assure that
individuals, agencies, and organizations have the
opportunity to participate in the development of goals,
objectives and strategies for community health
improvement.
Documentation –Board of health policy regarding public
participation in the development of goals, objectives and
strategies for community health improvement AND board
of health minutes reflecting that public participation
occurred or agenda indicating allocated time to encourage
public participation.
Benchmark Activities
To satisfy Benchmark 38:
Activity 38.1
Review of annual reports (i.e. 2015 CHA)
Activity 38.2 (review CHA data and citizen input):
Citizen input was received through surveys, focus groups, listening sessions
and during prioritization process and board participation was requested by
Liska Lackey during the March 2015 BOH Meeting.
Participated on the CHA committee’s (CHALT and Community Engagement)
Participated in Community Listening Sessions
Participated in HCOC’s Annual Meeting and prioritization process
Activity 38.3
Assure participation in goal, objective, and strategy development (i.e.
community health action plans)
Dissemination Requirements
Benchmark 1
Activity 1.3: The local health department shall disseminate
results of the most recent (2015) CHA to the local health
department’s stakeholders, community partners and the
general population.
Documentation: Evidence of CHA dissemination efforts by at
least 2 methods directed to stakeholders/community
partners AND the general population
Examples: Website, newsletter, news releases, meeting minutes
describing the presentation, etc.
Next Steps
1.CHA approval and dissemination
2.Continue and finalize community health action plans
around the 3 priority areas and present to you for
approval.
1.Will work through June with intentions to begin
implementation July 2016.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: March 23, 2016
Agenda Item Subject: Integrated Behavioral Health Pilot
Attachment(s): Powerpoint Presentation
Staff or Board Member Reporting: Kathleen Goodhand, Home Visiting Services
Supervisor, Hannah Welch, UNC-PrimeCare Intern & Andrea Mulholland, FNP
Purpose: X___ Action
_ _ Information only
____ Information with possible action
Summary Information: UNC-PrimeCare Intern Hannah Welch, Kathleen Goodhand
and Andrea Mulholland will provide an overview of the results of the integrated
behavioral health/prime care pilot and make a recommendation for funding a behavioral
health (Social Work Clinical Specialist) position.
The attached presentation details the need and projected cost for funding this position.
Background: Behavioral and social factors contribute to nearly every cause of death,
illness and disability (Journal of the American Medical Association 2004). As much as
85% of physician visits are for problems that have a significant psychological and/or
behavioral component (American Psychological Association 2016). Research has
shown that integrating mental health, substance abuse and primary care services,
enhances services, improves quality of care, reduces health care costs and produces
the best outcomes for caring for people with multiple healthcare needs.
In August 2015, we initiated integrated behavioral health as a part of the health
department’s primary care services. Utilizing a UNC-PrimeCare MSW Intern (UNC-
PrimeCare interns are masters in social work students, trained to work in primary care
settings as behavioral and mental healthcare specialists), we piloted providing
integrated behavioral health and prime care services in both OCHD clinics.
From August 2015 to February 2016, our UNC-PrimeCare Intern received 85 referrals
and provided services to 56 patients with mental or behavioral health issues and/or
substance abuse. Issues ranged from suicidality, postpartum depression, domestic
violence and PTSD to medication compliance, smoking cessation and anger
management.
Staff recommends that the Board of Health vote to approve the request for one
additional FTE for a Social Work Clinical Specialist to provide integrated behavioral
health services. The current fiscal year cost for salary and benefits is $6,323 and the
total annualized cost for this position is $79,694. Funds to cover this position will come
from the Medicaid Cost Settlement.
Recommended Action: ___Approve
X__Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
INTEGRATED BEHAVIORAL HEALTH &
THE ORANGE COUNTY HEALTH
DEPARTMENT
March 23, 2016
Integrating Behavioral Health: Why?
•Addressing mental health and physical problems in a comprehensive, coordinated way, saves lives and improves all patient health outcomes.
•Behavioral and social factors contribute to nearly every cause of death, illness and disability and cause approximately half of deaths each year (Journal of the American Medical Association 2004).
•> 50% of patients with a mental Health diagnosis are seen by their primary care provider (American Psychological Association).
•85% of physician visits are for problems that have a significant psychological component.
•45% of individuals who die by suicide have visited their primary care provider within a month of their death and over 75% had contact within one year. (Agency for Healthcare Research and Quality).
Integrating Behavioral Health: It Works!
Research and Data
Impacts of Integrated Behavioral Health
•Increased Patient, Family, and Provider Satisfaction1,3
•Increased Patient and System Outcome Improvements1,3,4
The Patient Protection & Affordable Care Act (PPACA)2,3
•Mental Health as a part of Physical Health
Incentives linked to patient and caregiver experience, care coordination,
safety, preventative health.
Prevention and Public Health Trust Fund to invest in
prevention, wellness, and public health activities (Sec.
4002)5
•ACA initially appropriated $500 million in FY 2010 increasing to $2
billion by 2022.*
OCHD Integrated Behavioral Health
Pilot: Goals
1.Improve patient health outcomes, by
integrating behavioral and mental health
services as part of OCHD clinical services.
2.Increase client access to and utilization of
behavioral and mental health services.
OCHD Integrated Behavioral Health
Pilot: Patients Treated
Total Number of Encounters: >300
•Encounters include phone calls and in-person visits
Total Number of Patients Referred: 85
•Whitted: 48
•Southern: 37
Total Number of Patients Served: 56
Total integrated visits: > 30
Total ongoing psychotherapy appointments: 71
OCHD Integrated Behavioral Health
Pilot Intervention
Behavioral Health services were provided in two main
ways:
•As requested by clinicians during a clinic visit. As patient
issues were identified, providers would ask Hannah to step in
to see a patient during a primary care visit. Hannah would
provide crisis management and/or other short term
interventions during these visits.
•Follow up interventions – for issues that required longer term
intervention - were provided by phone and through in person
counseling sessions, depending on needs.
OCHD Integrated Behavioral Health
Pilot: Conditions/Issues Addressed
•Substance abuse, suicidality, interpersonal violence.
Anxiety and Depression (many clients disclosed a history of trauma including sexual abuse, rape and human trafficking).
Mental Health conditions including bipolar disorder, eating and adjustment disorders and PTSD.
Stress Management, Social Isolation and Emotion Regulation issues.
Parenting and Child Behavior Management.
•Smoking Cessation, Medication Adherence and Healthy Goal Setting.
OCHD Integrated Behavioral Health:
Client & Provider Benefits
Patient
•Immediate, open access
to mental health services
•Safety net (many of these
clients have no insurance
and/or are unlikely to ever
seek traditional mental
health services)
•Less stigma
•Client comfort & safety
•Improved health
outcomes
Provider
•On-site, accessible
specialty care
•Support for clinic staff
•Better control of chronic
conditions
•Lower no-show rates
•Improved clinic efficiency
•Indispensable service!
•Lifeline for patients &
providers!
OCHD Integrated Behavioral Health Pilot:
Provider Feedback & Patient Examples
•Patient survived a recent sexual assault. Hannah used skills to provide crisis support, legal resource connection and ongoing trauma focused counseling.
•Postpartum patient suffering from shock of fetal demise, grieving and emotional at first clinic visit. Hannah provided immediate and ongoing counseling and coordinated with provider on additional physical treatment options.
•Patient newly diagnosed diabetic with a lot of stressors & personal crises. With Hannah’s interventions, diabetes in better control, which would not have been possible without integrative behavioral health care.
•Patient with untreated mood d/o for ‘years’ and former approach of referring her to outside services was not successful. Pt engaging in unhealthy, high risk behaviors. Pt has been in counseling with Hannah for several weeks, on mood stabilizer, stable, and will return to nursing school.
•One Monday, we had two new moms in distress, tearful and overwhelmed. Hannah was able to reach out, provide brief interventions to stabilize and then provide ongoing counseling.
•Patient with poorly controlled bipolar disorder in manic phase. Hannah was able to meet with patient & provide ongoing counseling services.
Recommendation & Costs
•Recommend funding 1FTE (Social Work Clinical
Specialist) to provide behavioral health services in
both OCHD clinics.
Line Item FY 2015-2016 Cost FY 2016-2017 Cost
Salary and Benefits $5,623 $74,694
Interpreter Costs $200 $2,400
Clinical Supervision Costs $500 $2,600
Total $6,323 $79,694
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: March 23, 2016
Agenda Item Subject: Strategic Planning Process Pt. I
Attachment(s): None
Staff or Board Member Reporting: Dr. Colleen Bridger
Purpose: _X__ Action
_ _ Information only
____ Information with possible action
Summary Information:
Today’s meeting is the first step in the 2016-2018 Strategic Planning Process. The
Board will identify/select 2-3 focus areas for each priority. Then, between the March
and May Board of Health meetings, each priority subcommittee will meet to discuss and
prioritize action steps for their focus areas, and report their recommended action steps
to the Board at the May 2016 Board of Health meeting. Subcommittee meetings will be
scheduled in the next two weeks, to take place in April and early May.
Background:
The 2015 Community Health Assessment is complete and the resulting priorities are:
1) Mental Health/Substance Abuse,
2) Social Determinants of Health (e.g., transportation, access to care, poverty), and
3) Physical Activity/Nutrition.
Keeping with the precedent from previous Board of Health Strategic Plans, the Chair
and Vice-Chair of the Board of Health have decided to adopt the same priorities as the
priorities listed above. The Board will go through a prioritization process together to
select the focus areas for each priority. Then, each subcommittee will work to select
their action steps for the 2016-2018 Board of Health Strategic Plan.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Accept as information
___Revise & schedule for future action
_X_Other (detail): Discuss and vote on focus areas for each
priority.
Health Director’s Report
March, 2016
• Last year the “human service departments” (Health, Social Services, Aging, Child Support and
Housing) asked for and received an Informatics Analyst position as part of the budget process.
Micah has been working with us for several months now on two data issues that are important
to all of us: Food Access and Transportation. She is providing us with comprehensive data that
will allow us to work with community partners and each other to ensure services around these
two issues are delivered effectively, efficiently and in a coordinated manor. More to come about
this great work.
• Earlier this month, I represented the Health Department at a statewide meeting facilitated by
ReThink Health. This national group has developed a modeling program that allows communities
to test the economic and health effects of various interventions (such as Hospice, Nutrition
Support and Hospital efficiencies). We spent several hours in our groups trying to find the sweet
spot between cost savings and health improvements. It was a fun exercise that reinforced the
importance of investing in preventive/population health services. The state’s AHEC is working
with ReThink Health to provide a train the trainer opportunity so we can engage more
communities in this great way to plan for the health of their communities. As soon as that is
available, I’ll invite them to one of our Board meetings.
• We conducted our mandatory full scale exercise…”operation whooping crane” last week. This
exercise tested our capacity to open and operate the Emergency Operations Center to
coordinate the delivery of mass vaccinations for pertussis. Overall the exercise went well and we
learned a lot about how to improve our process should the need arise. This was especially
impressive given that the Preparedness Coordinator position is vacant. Staff really came
together to help out and do the necessary to ensure the success of the exercise.
• Last Friday was the annual Department Head Retreat. We really are fortunate to have so many
dedicated, caring Department Heads in Orange County.
• We were notified last week that our long-time Medical Director, Dr. Julie Monaco will be leaving
UNC Family Medicine and thus the Health Department this summer. We will work together to
strategize how to move forward and recruit her replacement.
• I have my budget meeting with the Manager on Friday of this week, so will update you at the
BOH meeting how that went. Based on my experience last year, however, I doubt I’ll know much
about how we’ll fare.
• We’ve started another walking challenge and this time we have challenged two Health
Departments. I’m seeing a lot of staff taking quick walking breaks, conducting walking meetings
and generally just moving more! Thanks to the BOH members who are also competing with us!
Orange Co. health officials want to ban e-cigarettes in
restaurants, bars
By WNCN Staff Published: February 23, 2016, 11:51 am Updated: February 23, 2016, 7:30 pm
AP Photo/Frank Franklin II
HILLSBOROUGH, N.C. (WNCN) – Orange County Health officials are looking to ban
electronic cigarettes at restaurants and bars.
County health officials are citing new research for the change. Emerging research suggests
people who breathe in second-hand vapor from e-cigarettes could face potential health risks,
according to the Orange County Health Department.
“Some of those chemicals have been tested and are known irritants and some of them are known
to cause disease,” said Coby Jansen Austin, the Tobacco Prevention and Control Director for the
Orange County Health Department. “The board feels that given the current science, this is an
important move for them to take to help protect the health of people here in Orange County.”
Orange County Health officials said they would enforce the ban like the current smoking ban.
Marc Sylvestre, vice president of The Vapor Girl in Chapel Hill, believes the ban is premature
and calls it a “slap in the face for people who vape.”
“Right now the FDA is doing numerous studies on the effects of FDA vapor and they have not
yet found any dangerous evidence or harm from second hand vapor,” said Sylvestre. “I think it
will hurt business in Orange County because a lot of people are going to go to bars and
restaurants in Durham County or Alamance County where you’re allowed to vape.”
Last month — Durham County issued a ban on e-cigarettes on city and county property,
including parks, trails, and athletic fields. Orange County would be one of the first counties in
the state to pass an e-cigarette proposal in bars and restaurants.
Officials said it could take a couple of months to write the policy and they will seek public
comment. County health officials said a vote could come as early as March or April.
If the ban is passed, county health officials said there would be plenty of time for business
owners to prepare for the change before the new rule is implemented.
Orange County moves to ban e-cigarettes
MEGAN ROYER | PUBLISHED 02/22/16 10:47PM
CORRECTIONS: Due to a reporting error, the original version of this story misrepresented an Orange
County Board of Health memo. The memo was sent to health department staff. Due to another reporting
error, the original version of this story misrepresented the places e-cigarettes are banned. E-cigarettes
are banned in the Chapel Hill Public Library, some worksites and private businesses. The story has been
updated to reflect these changes.
Individuals who smoke e-cigarettes may not be able to do so inside bars and restaurants in Orange
County much longer.
The Orange County Board of Health sent a memo to health department staff, directing them to prepare
a policy that would prohibit the use of e-cigarettes in already smoke-free indoor areas of restaurants
and bars.
Coby Jansen Austin, senior public health educator at the Orange County Health Department, said
research from the Center for Disease Control and Prevention may suggest negative health effects are
not limited to only the users of e-cigarettes.
Austin said since e-cigarettes are relatively new products, they have not been around long enough to
study long-term risks. Using e-cigarettes indoors can lead to secondhand exposure to the aerosol, which
can irritate the lungs and eyes of people around e-cigarette smokers, Austin said.
“(This is) especially concerning for children with asthma and other people with respiratory problems,”
Austin said.
Austin also said some local high school students have expressed their concern regarding e-cigarette use
by peers.
“(We have seen) an overall increase in tobacco use among youth due to novelty products such as e-
cigs,” Austin said.
Mayor Pam Hemminger said in an email that the rise in e-cigarette use by middle school and high school
students is equally as concerning as the potential health problems from secondhand exposure to e-
cigarette aerosol.
Austin said places like the Chapel Hill Public Library and some worksites and private businesses have
already restricted the use of e-cigarettes.
She said the Board of Health hopes to have a draft of the rule for public feedback by April, and
implementation would happen by the fall.
“The county’s process to draft (the) policy will offer an opportunity to educate the public about the
hazards and benefits of e-cigarettes for users and others nearby,” Hemminger said.
Hemminger said she anticipates people with strong opinions on both sides of the e-cigarette discussion.
Town council member George Cianciolo said he does not anticipate a lot of opposition to the potential
policy.
“(For) restaurants that are currently banning regular cigarettes, (I) don’t think they will have a problem
with e-cigarettes,” Cianciolo said.
Cianciolo also said there is often no information as to what else is in the solution that generates the
vapor that e-cigarettes produce.
“It’s a good step forward, and from my perspective as a scientist, it’s a good step forward by the health
department,” Cianciolo said.
Cianciolo said he is concerned about issues of enforceability once the policy is implemented. He said,
generally, where Chapel Hill has had the biggest problem with smoking ordinances is people
complaining about others smoking at public places, like bus stops.
“You can pass laws, but enforcement of some are more difficult,” Cianciolo said. “We don’t have enough
folks to enforce (all of them).”
Cianciolo said the county and Town Council would need to see if there are different problems with
enforcing an e-cigarette policy as opposed to a regular cigarette policy.
Town council member Jessica Anderson is also concerned about the enforceability of the potential
policy for bars and restaurants.
“It’s on the business owner to enforce it, which is always hard,” she said. “It sounds like (the county is)
going to have to take that into account.”
Michael Schillinger, a bartender at Linda’s Bar and Grill in Chapel Hill, said he is not concerned that this
policy would affect business.
“Most people that come in here end up going outside to smoke real cigarettes,” Schillinger said.
He also said he has occasionally seen customers smoke e-cigarettes inside the bar, but no one seemed
to mind.
Similarly, Justin Dreaver, manager of Hickory Tavern in Carrboro, said he does not anticipate many
problems that may come with a new e-cigarette policy.
Dreaver said he has not seen any customers smoke e-cigarettes inside the restaurant in the time he has
been manager.
“I just moved from Florida, and I saw a lot more of that there,” Dreaver said. “Maybe (customers)
choose not to (use e-cigarettes) in here. My stance is more neutral. I don’t really have a problem with
it.”
@MeganRoyer
city@dailytarheel.com
Read more: http://www.dailytarheel.com/article/2016/02/orange-county-moves-to-ban-e-cigarettes
Quoted from The Daily Tar Heel
EDITOR'S PICK FEATURED
Orange County prepares for
health crisis
Keith Upchurch
March 10, 2016
Buy Now
The Herald-Sun | Whitney Keller
Ayeka Ruff, 14, right, waits to get a simulated vaccination from Doris Hill, a registered nurse with the Orange County
Health Department, left, during a full-scale public health preparedness exercise at Cedar Ridge High School in
Hillsborough on March 9, 2016. Orange County Health Department in partnership with Orange County Emergency
Services, Orange County Public Schools, and the Orange County Sheriff's Office held a mass vaccination exercise in
Cedar Ridge's gymnasium Wednesday afternoon. The Herald-Sun | Whitney Keller
Buy Now
The Herald-Sun | Whitney Keller
Rebekah Hermann, a registered nurse with the Orange County Health Department reaches for gauze during a full -
scale public health preparedness exercise at Cedar Ridge High School in Hillsborough on March 9, 2016. Orange
County Health Department in partnership with Orange County Emergency Services, Orange County Public Schools,
and the Orange County Sheriff's Office held a mass vaccination exercise in Cedar Ridge's gymnasium Wednesday
afternoon. The Herald-Sun | Whitney Keller
Buy Now
The Herald-Sun | Whitney Keller
Rebekah Hermann, a registered nurse with the Orange County Health Department, front left, talks with John Kase
during a full-scale public health preparedness exercise at Cedar Ridge High School in Hillsborough on March 9,
2016. Orange County Health Department in partnership with Orange County Emergency Services, Orange County
Public Schools, and the Orange County Sheriff's Office held a mass vaccination exercise in Cedar Ridge's
gymnasium Wednesday afternoon. The Herald-Sun | Whitney Keller
Buy Now
The Herald-Sun | Whitney Keller
Participants wait in line to receive a simulated vaccination during a full-scale public health preparedness exercise at
Cedar Ridge High School in Hillsborough on March 9, 2016. Orange County Health Department in partnership with
Orange County Emergency Services, Orange County Public Schools, and the Orange County Sheriff's Office held a
mass vaccination exercise in Cedar Ridge's gymnasium Wednesday afternoon. The Herald-Sun | Whitney Keller
HILLSBOROUGH -- Cammie Albert got a whooping cough shot Wednesday, and she
didn't feel a thing.
That's because she and other volunteers participated in a simulated mass vaccination at
Cedar Ridge High School to prepare officials if a real health emergency happens.
The public health preparedness exercise was sponsored by the Orange County Health
Department and other county agencies.
Volunteers gathered in the school's gym to fill out paperwork and get their "shots".
On Target Preparedness was hired to oversee the exercise.
"The Centers for Disease Control and the state require health departments to participate
in a full-scale exercise that does mass vaccinations or dispenses medications every five
years," On Target owner David Hasselmeyer said. "Any lessons learned will be
incorporated into future training exercises."
Cammie Albert, a junior at Cedar Ridge, said she volunteered because she wanted to
be prepared to help in a real crisis. She volunteers with the Civil Air Patrol, an au xiliary
of the U.S. Air Force, and wanted more experience in dealing with emergencies.
Denis Armstrong Carter, a sophomore at Cedar Ridge, decided to speak with a
Ukranian accent to add variety to the exercise.
"I like doing natural-disaster things, and it's fun to help the community," he said. "I
wanted to see how quickly we can respond to this."
Taylor Balog, a 10th-grader at Orange High School, also volunteers with the Civil Air
Patrol, where she participates in search operations.
"I came here to play the victim," she said before heading into the gym.
Also participating was 14-year-old Weston Hubbell, a student at C.W. Stanford Middle
School.
"I thought it would be interesting to help people be safe and help the community," he
said.
Stacy Shelp, public information officer for the Orange County Health Department, said
Wednesday's event should reassure the public.
"It's the best way to test and train your staff for a real-world scenario," she said. "It's not
just a plan that sits on a shelf. The more that we can be prepared for the unexpected,
the better it will be for all of us."
North Carolina Kids to 'Kick Butts' on March 16
State Leaders Urged to Make the Next Generation Tobacco-Free
WASHINGTON, March 11, 2016 /PRNewswire-USNewswire/ -- Kids in North Carolina will stand up to Big
Tobacco on March 16 as they join thousands of young people nationwide for Kick Butts Day. More than
1,000 events are planned across the United States and around the world for this annual day of youth
activism, sponsored by the Campaign for Tobacco-Free Kids. (See below for a list of local events.)
On Kick Butts Day, kids demand that tobacco companies stop marketing deadly products to them and
encourage elected officials to help reduce youth tobacco use.
This year, Kick Butts Day is focusing attention on the outrageous marketing tactics tobacco companies
still use to target youth. These tactics include:
•Splashy ads in magazines with large youth readership, such as Sports Illustrated, Glamour and Rolling
Stone.
•Widespread advertising and price discounts in stores, which make tobacco products appealing and
affordable to kids.
•Sweet-flavored tobacco products such as electronic cigarettes and small cigars that come in flavors like
gummy bear, cotton candy, watermelon and fruit punch. While youth cigarette smoking has fallen to
record lows, the most recent government survey shows that e-cigarette use among high school students
tripled from 2013 to 2014 (from 4.5 percent to 13.4 percent).
Nationwide, tobacco companies spend $9.6 billion a year – over one million dollars every hour – to
market tobacco products. In North Carolina, tobacco companies spend $392.2 million annually on
marketing efforts.
"On Kick Butts Day, kids stand up to the tobacco industry and all of us, especially our elected officials,
should stand with them," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids.
"We've made amazing progress in reducing youth smoking and can make the next generation tobacco-
free. Elected officials in every state should help reach that goal by supporting proven strategies to
prevent youth tobacco use, including higher tobacco taxes, strong smoke-free laws, prevention
programs and raising the tobacco age to 21."
In North Carolina, tobacco use claims 14,200 lives and costs $3.81 billion in health care bills each year.
Currently, 15 percent of North Carolina's high school students smoke.
On Kick Butts Day, kids join in creative events that range from classroom activities about the harmful
ingredients in cigarettes to rallies at state capitols.
In North Carolina, activities include:
An anti-tobacco rally will take place at the Education Building of the Winston-Salem Fairgrounds,
including school spirit booths, competitive events, and activities for all ages. The event will showcase the
students' year-round community efforts along with anti-tobacco pledges. Time: 4 PM. Location: 421
27th Street NW, Winston-Salem. Contact: Terri Moy (336) 705-9019.
The Butler DREAM Team will draw bodies with chalk around the entire perimeter of Butler High School
with a heavy emphasis on the entrances to parking lots and car pool lines. Stakes in the ground will
display tobacco facts to raise awareness. Time: 10:30 AM. Location: 1810 Matthews Mint Hill Road,
Matthews. Contact: Mary Ferreri (980) 343-6300.
Bike Routes for Fitness will host a cycling event in Charlotte to promote tobacco-free public spaces.
Bicyclists will ride a designated bus route and distribute literature, buttons and t-shirts to passengers on
city and school bus routes. Time: 2 PM. Location: 310 East Trade Street, Charlotte. Contact: Debra
Franklin (704) 886-8221.
On March 19th, the Orange County Health Department will partner with Tobacco Reality Unfiltered
(TRU) clubs in local high schools to raise awareness about the smoke-free public places rule. Participants
will collect cigarette butts in downtown Chapel Hill and Carrboro, share information on the policy, and
provide resources for quitting tobacco. Time: 10:30 AM. Location: Franklin Street, Chapel Hill. Contact:
Stacy Shelp (919) 245-2462.
All events are on March 16 unless otherwise indicated. For a full list of Kick Butts Day activities in North
Carolina, visit www.kickbuttsday.org/map. Additional information about tobacco, including state-by-
state statistics, can be found at www.tobaccofreekids.org.
Youth Anti-Smoking Events Planned For Wednesday
By Chris Grunert
Posted March 15, 2016 at 3:25 pm
Photo via Tobacco Free Kids
Young people across the country will gather on Wednesday to say no to smoking.
Kick Butts Day, like cigarette butts, is a day of activism against big tobacco companies and
youth smoking.
Gustavo Torrez is the director of youth advocacy for the Campaign for Tobacco Free Kids. He
says tobacco companies spend billions of dollars each year in advertising and much of that is
target at youth.
“The goal of Kick Butts day is truly to provide a space to young people to really come together
and say enough is enough, they’re tired of being marketed and target to by the tobacco industry,”
said Torrez.
According to the Center for Disease Control, cigarette smoke causes more than 480,000 deaths a
year in the United States.
Joshua Pritchett is a nationally recognized anti-tobacco youth advocate. He says a simple
awareness of the dangers of smoking is a deterrent to young people.
“It’s really just informing them. If you inform the youth and show them the effect it has on the
body, they take it in, they really do understand,” said Pritchett.
This year marks the 21st annual Kick Butts day and youth smoking has certainly decreased since
these events began.
“For the last 20 years we really been focusing on trying to reduce youth smoking rates and we’ve
done so by reducing the high school smoking rate more than half” said Torrez.
According to the CDC, 15.7% of high schools students in 2013 were smokers, down from 36.4%
in 1997.
Torrez said increasing taxes on cigarettes is another good way to reduce smoking, as well as
putting pressure on local government.
“We really need to reach out to our legislators to pass comprehensive smoke free air laws,” said
Torrez, “because we know that when we protect our communities from the dangers of second
hand smoke, we are having more conversations about the issues and the effects it’s having on our
community.”
Anti-smoking advocates are now dealing with a new wild card, E-cigarettes. Often advertised as
a safe alternative to traditional cigarettes, the FDA admits they have not been fully studied to
know all of the potential risks.
Torrez said E-cigarettes are also being heavily marketed to children.
“These products are being marketed with flavors like gumm y bears, cotton candy, watermelon,
which as you mentioned are very appealing to our young people,” said Torrez.
Torrez says we need more regulation of E-cigarettes. He warned that E-cigarettes could undo
some of the recent progress made by anti-smoking campaigns by getting kids addicted to
nicotine.
But Torrez said the ultimate goal of organization like the Campaign for Tobacco Free Kids, is to
create a smoke-free generation.
In the same anti-smoking spirit, the Orange County Health Department is partnering with
Tobacco Reality Unfiltered (TRU) clubs at local high schools to collected cigarette butts in
downtown Chapel Hill and Carrboro and provide resources to quit smoking this Saturday.
Kick Butts Day events are being held all across the country.
Durham 15th, Orange 2nd in N.C. health
rankings
Keith Upchurch
March 17, 2016
DURHAM -- Durham ranked 15th in health among North Carolina's 100 counties and Orange County
ranked second in an annual report released Wednesday.
Durham County dipped from 11th to 15th healthiest, according to the seventh-annual County Health
Rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health
Institute.
Although Durham County's overall ranking for 2016 dipped slightly, the county has consistently ranked
in the top 25 percent of counties in North Carolina, placing eighth in 2012 and 17th in 2013 and 2014.
Gayle Harris, director of the Durham County Department of Public Health, said building a healthy
community "is not an overnight process."
"Highs and lows are to be expected, as we transform our community," Harris said. "Although we have
made strides in many areas, some, such as child poverty and income inequality, are much more complex
and take years, if not a generation, to turn around."
Harris said Durham's health "goes far deeper than having world-class health care in our backyard.
Affordable housing, education, and income equality significantly impact overall health as well."
Harris said organizations including the Partnership for a Healthy Durham and annual meetings such as
the Duke-Durham Health Summit work to identify and tackle health problems.
Here are some of the study's findings for Durham County compared to North Carolina as a whole:
-- Premature deaths: 6,200 per 100,000 population compared to 7,200 statewide.
-- Access to exercise opportunities: 91 percent vs. 71 percent.
-- Children in poverty: 22 percent vs. 24 percent.
-- Children in single-parent households: 42 percent vs. 36 percent.
-- Uninsured: 18 percent vs. 18 percent.
-- Diabetic monitoring: 91 percent vs. 89 percent.
-- Violent crime: 648 per 100,000 population vs. 355 per 100,000 population statewide..
-- Severe housing problems: 19 percent vs. 17 percent.
The study cited the following "areas of strength" in Durham:
-- Mammography screening: 67 percent.
-- Unemployment: 5 percent.
"Areas to explore" include:
-- Adult smoking: 17 percent.
-- Adult obesity: 28 percent.
-- Sexually transmitted infections: 716 per 100,000 residents.
In Orange County, Dr. Colleen Bridger, director of the Orange County Health Department, said a
community's health is largely determined by its education and wealth.
"Orange County typically leads the way in both of these things, which is why it isn't surprising that we
are consistently ranked as one of the healthiest counties in the state," Bridger said. "Unfortunately,
what this doesn't show is the county's dramatic income inequality. Basically, we have a lot of people at
the top of the income scale and a lot of people at the bottom of the income scale."
Bridger said the county "is not resting on our ranking, but instead, we are taking action through
programs including the Family Success Alliance to battle the adverse effects of poverty by strengthening
a pipeline of success for our low-income families."
For more information, visit www.countyhealthrankings.org