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Agenda Packet April 20 2015PERSON COUNTY BOARD OF COUNTY COMMISSIONERS MEETING AGENDA 304 South Morgan Street, Room 215 Roxboro, NC 27573-5245 336-597-1720 Fax 336-599-1609 April 20, 2015 9:00 am CALL TO ORDER…………………………………………………. Chairman Puryear INVOCATION PLEDGE OF ALLEGIANCE DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA INFORMAL COMMENTS The Person County Board of Commissioners established a 10 minute segment which is open for informal comments and/or questions from citizens of this county on issues, other than those issues for which a public hearing has been scheduled. The time will be divided equally among those wishing to comment. It is requested that any person who wishes to address the Board, register with the Clerk to the Board prior to the meeting. ITEM #1 DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA A. Approval of Minutes of April 6, 2015, B. Budget Amendment #15, C. Tax Adjustments for April 2015, a. April 2015 tax releases, b. April 2015 NC Vehicle Tax System pending refunds, and D. JCPC Funding Recommendations for FY2015-2016 UNFINISHED BUSINESS: ITEM #2 Radio, Telephone and TV Transmitting Tower Setback Language ….. Mike Ciriello 1 NEW BUSINESS: ITEM #3 Solid Waste Management Study RFP and Environmental Testing Results from the Upper Piedmont Environmental Landfill ………………. Sybil Tate ITEM #4 Duke Energy Progress Neighborhood Energy Saver Program ……….. Evans Taylor ITEM #5 Resolution Requesting Abandonment of a portion of State Road 1401 …. Alan Hicks ITEM #6 Volunteer Fire Departments and Rescue Audits …. Heidi York & Amy Wehrenberg ITEM #7 2014 Community Health Assessment ……………………………… LeighAnn Creson ITEM #8 Call for Public Hearing for Economic Development Incentives for the Hall’s Agribusiness project ………………………… Stuart Gilbert ITEM #9 Appointment of a member to the special Board of Equalization and Review ………………………………………………… Russell Jones ITEM #10 Adoption of Capital Improvement Plan FY2016-2020 …………………… Heidi York & Amy Wehrenberg ITEM #11 Proposal to Lease to the State of NC .………………………………………. Sybil Tate CHAIRMAN’S REPORT MANAGER’S REPORT COMMISSIONER REPORTS/COMMENTS CLOSED SESSION #1 Closed Session per General Statute 143-318.11(a)(5) to consider the acquisition or lease of real property with the following individuals permitted to attend: County Manager, Heidi York, Clerk to the Board, Brenda Reaves, County Attorney, Ron Aycock, Assistant County Manager, Sybil Tate, and General Services Director, Ray Foushee ITEM #12 Review of the Senior Center Site Options ………………. Heidi York & Ray Foushee Note: All Items on the Agenda are for Discussion and Action as deemed appropriate by the Board. 2 April 6, 2015 1 PERSON COUNTY BOARD OF COMMISSIONERS APRIL 6, 2015 MEMBERS PRESENT OTHERS PRESENT April 6, 2015 2 Expand Districts Allowing “Radio, Telephone and TV Transmitting Tower(s)” Mr. Cirello stated “Radio, Telephone and TV Transmitting Tower(s)” are not allowed in Neighborhood Shopping District (B-1) and Highway Commercial Business District (B-2). Mr. Ciriello requested Board consideration to add to the Table of Permitted Uses, to allow “Radio, Telephone and TV Transmitting Tower(s)” in Neighborhood Shopping District (B-1) and Highway Commercial Business District (B-2). PERMITTING PROCESS OPTION #1: Special Use Permit (Do nothing) Mr. Ciriello noted a Special Use Permit requires a public hearing by the Planning Board to which the Planning Board makes a recommendation during the public hearing held by the Board of Commissioners. The project application may be approved with conditions, approved as presented, or denied. The process takes 60 to 90 days. The existing Table of Dimensional Requirements would have no limits on the height of television and radio masts, aerials and towers. Setbacks would be no more than 40’ but no less than 8’ from property lines. This process takes 7 – 10 working days for plans to be reviewed and a zoning permit to be issued. Mr. Ciriello stated the Board may consider adding height limits and setbacks for radio, telephone and TV transmission towers. PERMITTING PROCESS OPTION #2: Use-by-Right (Administrative Permit) Use-by-Right allows a zoning permit to be issued administratively. If an application is complete, this process takes no more than 48 hours. No public hearing is required. Mr. Ciriello stated the Board may consider adding height limits and setbacks for radio, telephone and TV transmission towers. PERMITTING PROCESS OPTION #3: Combination of Option 1 and 2 Mr. Ciriello recommended the third option to consider “Radio, Telephone and TV Transmitting Tower(s)” a Use-by-Right in one or more zoning district but, require a Special Use Permit in other districts. This would require changing the Table of Permitted Uses, for example, to allow as a Use-by-Right “Radio, Telephone and TV Transmitting Tower(s)” in the General Industrial (GI), but require a Special Use or Conditional Use Permit in Residential (R) and Rural Conservation (RC) zoning districts. Mr. Ciriello requested, if the Board prefers Option #3, to consider adding height limits and setbacks for radio, telephone and TV transmission towers to Section 75. Mr. Ciriello stated there was no current requirement or need to have height restrictions unless a tower exceeded 2000 ft. which would trigger FCC regulations for flight path restrictions. Mr. Ciriello recommended the setbacks for radio, telephone and TV transmission towers should be the same distance as the height of the tower to offer protection to adjacent property owners. 4 April 6, 2015 3 County Manager, Heidi York asked Mr. Ciriello for proposed language for Section 75 related to the height and setback requirements. Mr. Ciriello yielded for direction from the Board of Commissioners noting he would refer to the language in the current ordinance, i.e. setback would have to be equal to the height of the tower unless engineering certified for a fall zone less than the height. Mr. Ciriello stated setback requirements may be different dependent upon the type of tower. Mr. Ciriello stated he did not think Person County needed height limitations for towers noting the unlikely event that Person County would have application for towers over 2,000 ft. Commissioner Jeffers stated interest in the approved height of the Long’s Store Road and Wagstaff Road towers. There were no individuals appearing before the Board to speak in favor of or in opposition to the Board repealing the Person County’s Wireless Telecommunications Facilities Ordinance. A motion was made by Commissioner Kendrick and carried 5-0 to close the public hearing for consideration to repeal Person County’s Wireless Telecommunications Facilities Ordinance. CONSIDERATION TO REPEAL PERSON COUNTY’S WIRELESS TELECOMMUNICATIONS FACILITIES ORDINANCE: A motion was made by Commissioner Kendrick to repeal Person County’s Wireless Telecommunications Facilities Ordinance and to add to the Table of Permitted Uses, to allow “Radio, Telephone and TV Transmitting Tower(s)” in Neighborhood Shopping District (B-1) and Highway Commercial Business District (B-2), and approve Permitting Process Option #3 as presented to consider “Radio, Telephone and TV Transmitting Tower(s)” a Use-by-Right in one or more zoning districts but, require a Special Use Permit in the other districts. This would require changing the Table of Permitted Uses, for example, to allow as a Use-by-Right “Radio, Telephone and TV Transmitting Tower(s)” in the General Industrial (GI), but require a Special Use or Conditional Use Permit in Residential (R) and Rural Conservation (RC) zoning districts. When asked for unintended consequences, Mr. Ciriello stated the lack of guidance in the language defining the standards as well as a tower in a residential use to have impact on property values. Mr. Ciriello suggested consideration for GI, Business 1 and Business 2 where allowed as a use by right, to allow as a use by right unless adjacent to an existing residential property to which a Special Use Permit is required. 5 April 6, 2015 4 An amended motion was made by Commissioner Kendrick and carried 5-0 to repeal Person County’s Wireless Telecommunications Facilities Ordinance and to add the language and instructions to staff as indicated to effectuate the repeal as follows: to add to the Table of Permitted Uses, to allow “Radio, Telephone and TV Transmitting Tower(s)” in Neighborhood Shopping District (B-1) and Highway Commercial Business District (B- 2), and approve Permitting Process to consider “Radio, Telephone and TV Transmitting Tower(s)” a Use-by-Right in one or more zoning districts but, require a Special Use Permit in the other districts. This would require changing the Table of Permitted Uses to allow as a Use-by-Right “Radio, Telephone and TV Transmitting Tower(s)” in the General Industrial (GI), Neighborhood Shopping District (B-1) and Highway Commercial Business District (B-2) zoning districts, but require a Special Use or Conditional Use Permit in Residential (R) and Rural Conservation (RC) and in the case(s) in General Industrial (GI), Neighborhood Shopping District (B-1) and Highway Commercial Business District (B-2) when adjacent to an existing residential use. Setbacks are required to be the same as the height of the structure unless the fall-zone for the structure is certified to be less than the height. Ms. York offered to bring back to the Board the recommended language in the amended ordinance at the Boards’ next meeting. PUBLIC HEARING FOR THE PERSON COUNTY MULTI-JURISDICTIONAL HAZARD MITIGATION PLAN: A motion was made by Vice Chairman Newell and carried 5-0 to open the duly advertised public hearing for the Person County Multi-Jurisdictional Hazard Mitigation Plan. Will Brooks, Project Consultant for Kerr-Tar Council of Government provided an overview of the Person County Multi-Jurisdictional Hazard Mitigation Plan update for 2015. Mr. Brooks noted the change to a multi-jurisdictional plan combined with the City of Roxboro and was deemed appropriate by the NC State Emergency Management. Mr. Brooks stated local hazard mitigation planning is a requirement under the Disaster Mitigation Act of 2000 for Federal and State declared natural disaster recovery assistance for grant eligibility and supporting mitigation programs. The plan update addresses both the County and City of Roxboro’s assessment of disaster mitigation practices; thus, satisfying all required FEMA planning elements as a multi-jurisdictional plan. Mr. Brooks stated the last plan update was prepared in 2009 for the County and in 2010 for the City of Roxboro. Mr. Brooks stated the five-year Multi-Jurisdictional Hazard Mitigation Plan update was submitted to NC Emergency Management in December 2014, following a joint Planning Board meeting, and was approved in February 2015. Mr. Brooks noted that preliminary approval has been received from FEMA in March 2015 with final approval pending local adoption which required a public hearing. Mr. Brooks stated the City Council would be considering the same plan update at their meeting on April 14, 2015. 6 April 6, 2015 5 Mr. Brooks stated the plan process allowed for an evaluation of the previous update for effectiveness and allowed for needed changes. Mr. Brooks outlined the main four community goals in the plan update as follows: Goal #1 Protect the public health, safety and welfare by increasing public awareness of hazards and by encouraging collective and individual responsibility for mitigating hazard risks. Goal #2 Improve technical capability to respond to hazards and to improve the effectiveness of hazard mitigation actions. Goal #3 Enhance existing or create new policies and ordinances that will help reduce the damaging effects of natural hazards. Goal #4 Protect the most vulnerable populations, buildings, and critical facilities through the implementation of cost-effective and technically feasible mitigation actions. Mr. Brooks stated new mitigation actions included in the plan update are: • Both the County and City Planning Departments will periodically make various hazard education items available through various media outlets-websites, newspaper, and radio. • Enforce Stormwater Ordinance for new and redevelopment on residential and commercial properties. • Ensure adequate evacuation warning in case of major hazard event. • Maintain/Improve shelter capacities with alternate power/heat sources. Commissioner Jeffers asked Mr. Brooks to address the funding sources noting the plan update stated that the City and County will rely heavily on local funding sources to fulfill most of the Plan obligations; however, both will also seek funds from interested State and Federal agencies for both pre-and post-disaster activities. Mr. Brooks stated the support from the NC State Emergency Management for Person County and the City of Roxboro to jointly participate in the Hazard Mitigation Plan noting the unlikely event that there will be a state or national disaster to affect one entity and not the other. Mr. Brooks requested the Board to approve a Resolution of Adoption of a five-year update to the Person County – City of Roxboro Hazard Mitigation Plan. There were no individuals appearing before the Board to speak in favor of or in opposition to the Person County Multi-Jurisdictional Hazard Mitigation Plan. A motion was made by Vice Chairman Newell and carried 5-0 to close the public hearing for the Person County Multi-Jurisdictional Hazard Mitigation Plan. 7 April 6, 2015 6 CONSIDERATION TO APPROVE RESOLUTION OF ADOPTION FOR THE PERSON COUNTY – CITY OF ROXBORO HAZARD MITIGATION PLAN: A motion was made by Commissioner Clayton and carried 4-1 to approve the Resolution of Adoption for the Person County – City of Roxboro Hazard Mitigation Plan. Commissioner Kendrick cast the lone dissenting vote. 8 April 6, 2015 7 A copy of the Person County – City of Roxboro Hazard Mitigation Plan adopted in 2015 is hereby incorporated into the minutes by reference and will be on file in the Office of the Clerk to the Board. 9 April 6, 2015 8 INFORMAL COMMENTS: The following individuals appeared before the Board to make informal comments: Mr. Wayne Wrenn of 2375 Poindexter Road, Hurdle Mills, and President of the Fire Chief’s Association thanked the Board of Commissioners and County Staff on behalf of the Fire Chief’s Association for responding to their concerns to place the county appropriation funding amount in each of the volunteer fire and rescue contracts and for proposing a Capital Reserve Program to address their capital needs. Mr. Wrenn also thanked Commissioner Jeffers for his attendance to their meetings and his advocacy to the volunteer fire departments and rescue. Ms. Betty Blalock of 144 Tirzah Ridge, Rougemont gave the Board and the County Manager a handout depicting her personal experience noting impacts from the landfill, a photo of a graveyard near the landfill and a report of options on waste management urging the Board to do nothing. DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA: A motion was made by Chairman Puryear and carried 5-0 to approve the Consent Agenda with the following items: A. Approval of Minutes of March 16, 2015, B. Proclamation for the Week of the Young Child, and C. Budget Amendment #14 UNFINISHED BUSINESS: SECOND READING FOR AN AMENDMENT TO THE AUTOMOBILE GRAVEYARD AND JUNKYARD ORDINANCE: A motion was made by Commissioner Jeffers, and carried 5-0 to revive consideration for the Second Reading for an Amendment to the Automobile Graveyard and Junkyard Ordinance. Planning Director, Michael Ciriello recalled at the Board of Commissioners’ March 2, 2015 meeting, amendments were presented for consideration to the Automobile Graveyard and Junkyard Ordinance to which staff was asked to clarify and change the time limit on the second notice to 30 days as well as review the definition of junk. By action of the Board on March 2, 2015, the item was tabled thereby necessitating a motion to revive consideration. Mr. Ciriello summarized the key points of the proposed amendment to the Automobile Graveyard and Junkyard Ordinance as follows: 10 April 6, 2015 9 • Adds definition of “Establishment” to mean “commercial” operations • Adds clarification about the applicability of the ordinance to residential properties • Does not apply to residential properties that are not visible from adjacent residential or public uses (schools, playgrounds) on adjacent properties or from public roads or to farms as defined by State statute and construction sites with currently active permits; • Enforcement process managed by the Planning Department • Specific abatement process would apply to “chronic offenders”; costs would be applied to property tax bill • Appeals heard by Board of County Commissioners • 2nd notice allows for 30 days to remedy violation Chairman Puryear stated the proposed amendments expand the ordinance for enforcement purposes noting the appeal process is with the Board of Commissioners. Commissioner Kendrick stated his opposition to the ordinance and regulating what residents may or may not do on their own property. Commissioner Jeffers stated three of the five exceptions listed in the ordinance area as follows: A. Ordinance shall not apply to residential properties that are not visible from residential or public uses (schools, playgrounds) on adjacent properties or from public roads. B. Ordinance shall not apply to service stations or repair shops unless said service station or repair shop has on or inoperable motor vehicles which are not being restored to operation. C. This ordinance shall not apply to bona fide farm properties as defined by NCGS §153A-340. Mr. Ciriello stated the objective was to protect property values and that any violations not visible are not subject to enforcement. Mr. Ciriello confirmed that compliance would only be reviewed when a complaint is received. A motion was made by Commissioner Jeffers and carried 4-1 to approve the amendments to the Automobile Graveyard and Junkyard Ordinance. Commissioner Kendrick cast the lone dissenting vote. 11 April 6, 2015 10 12 April 6, 2015 11 13 April 6, 2015 12 14 April 6, 2015 13 15 April 6, 2015 14 16 April 6, 2015 15 17 April 6, 2015 16 REVIEW OF THE SENIOR CENTER SITE OPTIONS: Heidi York, County Manager reminded the Board at its March 16, 2015 meeting Brockwell Associates presented four options for the Board’s consideration for the construction of a senior center. These options included: Option 1: Hotel Lot new construction of 12,000 sq. ft. on existing vacant hotel lot $2.35M Option 1a: Hotel Lot new construction of 12,000 sq. ft. designed to mimic old hotel $2.35M Option 2: Renovate Existing Senior Building (2 Story, 12,000 sq. ft.) $2.52M Option 3: New Construction on Existing Senior Lot (2 Story, 12,000 sq. ft.) $2.61M Option 4: New Construction of an Addition plus Renovation of 6,000 sq. ft. of existing: $2.27M for 12,000 sq. ft. $2.51M for 14,000 sq. ft. $3.11M for 18,000 sq. ft. Commissioners Clayton and Jeffers asked the Board to look at the option of acquiring property to connect and tie in the parcels that the City of Roxboro plans to convey to the County for the senior center project. Commissioners Clayton and Jeffers asked Mr. Brent Davis of Brockwell Associates about the possibility of the Oakley property near the site of the former senior center to be used as part of the construction process. Mr. Davis stated he had only seen the building from outside noting it has approximately 7,800 sq. ft. in space; the Oakley property abuts the Rock City Gun Shop building. Mr. Davis stated there is currently basement access on the Oakley property into the gun shop building. Ms. York told the Board that a Closed Session would be appropriate if the Board would like to further discuss acquisition of property, including the property’s tax and appraised values. Commissioner Kendrick stated his support to move forward with the previously presented Option 4 noting Option 4 was probably the best overall option with the most potential. Chairman Puryear stated his first priority was to create a suitable space for the seniors and he agreed with Commissioner Kendrick favoring Option 4 with 12,000 sq. ft. Commissioner Jeffers requested Board consideration to check on the possibility of obtaining the Oakley building prior to the Board’s April 20, 2015 meeting and delay a decision on the senior center construction option until the Board’s next meeting. A motion was made by Commissioner Jeffers and carried 3-2 to delay review of the Senior Center site options to the Board’s April 20, 2015 meeting with direction to staff to review the Oakley property for suitable use as well as to obtain a purchase price. 18 April 6, 2015 17 NEW BUSINESS: REGION K COMMUNITY ASSISTANCE CORPORATION’S REQUEST FOR CONTINUED FINANCIAL ASSISTANCE TOWARDS THE SENIOR CENTER RENT: County Manager, Heidi York said the Region K Community Assistance Corporation (the non-profit arm of the Kerr Tar Regional Council of Government) has requested continued assistance from the County towards the Senior Center rent at The Perfect Venue for the new rental lease period of April 1, 2015 – March 31, 2017. Ms. York stated Person County Government has contributed $600 per month towards the monthly rent of $1700 during the past year noting the City of Roxboro also contributed $600 per month and the Region K Community Assistance Corporation contributing $500 per month through the lease period that ended in March 2015. The renewal lease, according to Maynell Harper, Aging Services Interim Director is a period of 24-months for the same monthly rental fee of $1,700 and included a 30-day walk-away notice should a new senior center location be ready prior to the end of March 2017. Ms. York stated this same request was also presented to the City and they agreed to fund rental assistance through the end of June with intentions of discussing the funding during their budget deliberations for FY16. Ms. York reminded the Board that the County also provides an annual appropriation of $100,000 towards operating expenses for the Senior Center. A motion was made by Commissioner Clayton and carried 3-2 to approve the request from the Region K Community Assistance Corporation for Person County to continue financial assistance toward the Senior Center monthly rent in the amount of $600 from April 1, 2015-March 31, 2017. Chairman Puryear and Commissioners Clayton and Jeffers voted in support of the motion. Vice Chairman Newell and Commissioner Kendrick opposed the motion. 19 April 6, 2015 18 CONSIDERATION TO ABOLISH THE SPECIAL BOARD OF EQUALIZATION AND REVIEW FOR 2015 AND FORWARD: Chairman Puryear and Russell Jones, Tax Administrator stated the Person County Board of County Commissioners adopted a resolution establishing a special Board of Equalization and Review on January 7, 2013, and amended the resolution on January 22, 2013 (adding 3 alternate members). Both resolutions were passed by a unanimous vote and members were appointed for 4-year terms. Mr. Jones said that Person County joined the majority of counties when this special board was created (62 counties out of 100 are currently utilizing a special Board of Equalization and Review). Mr. Jones noted that after the creation of the special Board of Equalization and Review, the Person County Tax Office and the North Carolina Department of Revenue held a training session for all members. The meeting was held on April 11, 2013 and was recorded by Person County Information Technology. The training is available on-line at http://www.personcounty.net for review. The newly created Board of Equalization and Review began meeting on April 22, 2013 with 100% attendance. This board had 23 meetings in 2013, amounting to over 80 hours in meeting time alone, and heard over 500 appeals. Their final meeting for 2013 was completed on July 18, 2013. Mr. Jones stated the appeals for 2014 were much less, with only 26 appeals. This was to be expected, since most appeals occur during a revaluation year. Mr. Jones summarized that approximately 50 appeals advanced past the local board of equalization and review to the state level for appeal noting 2 have yet to be heard and all other appeals with the exception of 1 were supported by the same vote as the special Board of Equalization and Review of Person County. Vice Chairman Newell stated his experience had been if relief was not gained from the local equalization and review board that citizens could not justify the expense to appeal to the state level. North Carolina General Statute 105-322(a) allows for the creation of a special Board of Equalization and Review if a resolution is adopted by the Board of County Commissioners on or before the first Monday in March. While there is a specific deadline for establishing the special Board of Equalization and Review, there is no deadline for abolishing the special board; this can be done at any time, with the adoption of a new resolution. Mr. Jones stated the only way the current board members could be terminated at this time would be to abolish the board with a new resolution. Mr. Jones presented reasons to consider abolishing this special Board of Equalization and Review: 20 April 6, 2015 19 1. Fewer Appeals. There could be fewer appeals since this is non-revaluation year. 2. Consistency. There could be more consistency since there will not be alternate members involved (same 5 commissioners will hear all appeals). 3. Savings. Since the special Board of Equalization and Review members were reimbursed either $50 or $150 per meeting, this expense can be eliminated from the tax office budget. The member reimbursement for 2013 was $12,800 and for 2014 was $1,150. Mr. Jones informed the Board that if a Resolution to Abolish the Special Board of Equalization and Review is adopted, the following points should be addressed: a. First meeting date. This meeting must be advertised at least 10 days prior to the first meeting date, according to NCGS 105-322(f). If determined tonight, the opening meeting must be no earlier than April 20th and must be no later than May 4th. At best, there is only a 14 day window remaining to have the opening meeting for the Board of Equalization and Review. b. Date to adjourn for accepting new appeals. The Board must set a date to adjourn for accepting new appeals. It is recommended that the appeal window be open for 2 weeks in a non-revaluation year, and the Board must be in session in order to adjourn for the acceptance of new appeals. This will need to be a set time and date and must also be advertised. It would be acceptable to hear appeals at that time also. c. Hearing Dates. After adjourning for the acceptance of new appeals, the Board may need to set up times for all timely filed appeals to be heard. The adjournment under item b is only for the filing of the appeals. Appeals that were timely filed can be heard at a later date, but should be finished by July 1st in a non-revaluation year. e. Scheduling. The Board will need to determine the time allotment for each taxpayer for scheduling purposes. The special Board of Equalization and Review allowed 15 minutes per taxpayer, with 5 additional minutes if the taxpayer appealed additional parcels. This is not a requirement, but this is much more taxpayer friendly than having all appeals scheduled at the same time and having taxpayers waiting for hours. The tax office will notify the taxpayers of their designated time and accept 7 copies of all evidence from the taxpayer, along with their appeal form, and have these available for the meeting. f. Location. The Board will need to determine where the meetings will be held. Before the special Board of Equalization and Review was established, the meetings were held in the Commissioner's Board Room, the meetings were streamed live, and also posted to the county website. If held at this location, taxpayers that appeal without an appointment may have to be rescheduled, since the tax office records will be located at a different location. An alternate location would be the tax office conference room, which was utilized by the special Board of Equalization and Review for 2013 and 2014. 21 April 6, 2015 20 Chairman Puryear advocated to adopt a Resolution to Abolish the Special Board of Equalization and Review as he feels the process is an elected duty. Vice Chairman Newell agreed with Chairman Puryear that the process should revert back to the Board of Commissioners. Commissioner Jeffers stated that with the exception of the one alternate member, Faye Boyd, all members were either current or former commissioners and he was not aware if the members were willing to continue to serve or had notice that the special Board of Equalization and Review was proposed to be abolished. Mr. Jones stated as a Board of Equalization and Review, each member takes an oath much like the oath for a commissioner that also disallows political obligations nor could personal friendships influence decisions. Commissioner Kendrick asked if the Board of Commissioners could attend and/or comment along with the Board of Equalization and Review so not to disband the current members. Mr. Jones stated the Board of Equalization and Review meets in open session and hears evidence from the tax payer and/or their attorney as well as the County Tax Office. The board will then deliberate and make a decision in open session. Mr. Jones stated a commissioner attending a Board of Equalization and Review meeting will be doing so as a citizen without decision making capability or a time to comment. Mr. Jones clarified the Board’s resolution in 2013 had criteria to be eligible for appointment which was a) property ownership and b) be in good standing with their property taxes. Mr. Jones outlined the three options for Board consideration: 1) To leave the special Board of Equalization and Review as in, 2) To abolish the special Board of Equalization and Review and revert back to the Board of Commissioners to serve in this capacity, or 3) Wait to make a change in 2017 when the Board members’ term have expired. Commissioner Kendrick stated the outcome of the 2014 appeals as described by Mr. Jones reflected the special Board of Equalization and Review members’ knowledge of the process. Mr. Jones added the current members of the Board of Equalization and Review are very dedicated, attended the meetings, prepared for the meetings noting alternates were only used at 8 of 23 meetings in a member’s absence. Commissioner Jeffers noted his opposition to abolish the current members from the special Board of Equalization and Review. A motion was made by Vice Chairman Newell and failed 2-3 to abolish the special Board of Equalization and Review and revert the responsibilities of the Board of Equalization and Review back to the Board of Commissioners. Vice Chairman Newell and Chairman Puryear voted in support of the motion. Commissioners Kendrick, Clayton and Jeffers voted in opposition to the motion. 22 April 6, 2015 21 RECOMMENDED CAPITAL IMPROVEMENT PLAN FOR FY 2016-2020: Heidi York, County Manager presented the Recommended Capital Improvement Plan (CIP) for FY 2016-2020 noting the CIP is a planning tool for implementing large, capital projects. The CIP includes projects costing $50,000 or greater from county departments, Piedmont Community College and Person County Schools. Ms. York stated the CIP paves the way for the Recommended Budget as it will provide an estimate of funding needed for capital projects and projects impacts on operating costs as well. These capital projects span the next five fiscal years with the upcoming fiscal year (FY16) being the only year funded. Ms. York gave the Board copies of a presentation highlighting the recommended capital project for each FY16, FY17, and FY18. Ms. York stated the CIP is scheduled to be adopted at the Board’s meeting on April 20, 2015. Commissioners Jeffers noted the new voting equipment (FY16 appropriation of $247,400) is an unfunded mandate from the state. The Recommended CIP as delivered to the Board follows: 23 April 6, 2015 22 24 April 6, 2015 23 25 April 6, 2015 24 26 April 6, 2015 25 27 April 6, 2015 26 28 April 6, 2015 27 29 April 6, 2015 28 30 April 6, 2015 29 31 April 6, 2015 30 32 April 6, 2015 31 33 April 6, 2015 32 34 April 6, 2015 33 35 April 6, 2015 34 36 April 6, 2015 35 37 April 6, 2015 36 38 April 6, 2015 37 39 April 6, 2015 38 40 April 6, 2015 39 41 April 6, 2015 40 42 April 6, 2015 41 43 April 6, 2015 42 44 April 6, 2015 43 45 April 6, 2015 44 46 April 6, 2015 45 PIERCE GROUP BENEFITS: Mr. Chris Pierce of Pierce Group Benefits introduced Mr. Glenn Pierce and Ms. Donna Dixon, Director of Group Benefits. Mr. Pierce asked the Board to consider authorizing the County Manager to sign an agent of record with Pierce Group Benefits to allow them the opportunity to prepare a strategy plan for county employee’s benefits using their buying power for substantial savings for better rates and programs to change employee health behaviors. Mr. Pierce and Ms. Dixon told the Board their Group could save Person County $50,000 immediately with potential for more savings for employee health benefits. Mr. Pierce noted Pierce Benefits Group has worked with Person County Schools the last eight years and with the City of Roxboro the last three years. Mr. Pierce confirmed the immediate $50,000 savings would be in the form of a decrease of agent commission. Person County’s current broker’s commission is currently presented at $81,000. Mr. Pierce noted that Alamance County signed on with Pierce Benefits Group this date which resulted in a 40% reduction in costs for their vision benefits plan. Mr. Pierce and Ms. Dixon gave the Board the following presentation: 47 April 6, 2015 46 48 April 6, 2015 47 49 April 6, 2015 48 50 April 6, 2015 49 51 April 6, 2015 50 52 April 6, 2015 51 CHAIRMAN’S REPORT: Chairman Puryear reported the following: • Person County Partnership for Children will hold a Child Abuse Prevention awareness event to plant a pinwheel on April 10, 2015 at 10:00 am at Union Bank, • He participated in recent ribbon cuttings at the Roxboro Country Club and at Palace Pointe, and • He would like to meet with Commissioner Jeffers regarding the Strategic Plan update committee member list. MANAGER’S REPORT: County Manager, Heidi York reported the following: • Some of the past Strategic Plan members have been contacted and she has some informal quotes for a consultant if the Board is interested, and • The Airport Commission will be meeting on April 9, 2015 at 10:00 am at the Airport. COMMISSIONER REPORT/COMMENTS: Commissioner Jeffers reported on the following: • 4-H Advisory Council meeting noting upcoming 4-H events to support; donate at Tractor Supply, Livestock Auction, Golf Tournament, and • the volunteer fire departments and rescue discussed the term of the contract and are fine with keeping as a two-year contract as long as the funding amount is included. Commissioner Clayton reported the General Assembly is currently considering legislation that may impact the reorganization of sales tax and economic development incentives. Commissioner Jeffers added that changes may be forthcoming with the Medicaid Swap. Commissioner Kendrick had no report. 53 April 6, 2015 52 Vice Chairman Newell commented he would like to have a firm rate from Pierce Group Benefits for a price comparison. Mr. Pierce of Pierce Group Benefits stated a letter for an agent of record would need to be authorized in order to review claim data and go out to the market for competitive bids. Mr. Pierce requested the Board to allow them to have 30 days to submit a proposal. It was the consensus of the Board to allow Person County’s current broker, Mr. Phillip Allen to address the Board. Mr. Allen stated that Vice Chairman Newell had requested to negotiate the agent commission as well as Commissioner Clayton had requested plan benefit changes to which he was in the process of revising his proposal for the County and he asked the Board to allow him the opportunity to complete his proposal and to deliver to staff in the next few days. Chairman Puryear asked the Board if the desire was to place employee benefits on the Board’s April 20, 2015 agenda. Staff members noted in the essence of time, a decision was needed prior to April 20, 2015. Chairman Puryear stated the Board took unanimous action at the last meeting to remain with the current broker and Coventry. It was the consensus of the Board to allow Mr. Allen to complete his revised proposal for Person County. ADJOURNMENT: A motion was made by Commissioner Kendrick and carried 5-0 to adjourn the meeting at 9:11 pm. _____________________________ ______________________________ Brenda B. Reaves Kyle W. Puryear Clerk to the Board Chairman (Draft Board minutes are subject to Board approval). 54 4/20/2015 Dept./Acct No.Department Name Amount Incr / (Decr) EXPENDITURES General Fund General Government 3,484 Public Safety 75 Economic Development 1,415 Culture and Recreation (192,410) Human Services 79,407 Contingency (3,484) REVENUES General Fund Intergovernmental 79,107 Charges for Services 1,415 Other Revenues 3,840 Fund Balance Appropriation (195,875) Explanation: BUDGET AMENDMENT Transfer from Property and Liability Contingency (-$1,664) to Human Resources ($1,664) for Sheriff's bond insurance and coverage of new EMS ambulance replacement; Receipt of donation to EMS ($2,000); receipt of insurance proceeds for wind damage to Parks and Recreation vehicles ($2,650); transfer contigency funds (- $1,820) to Legal for professional services costs ($1,820); receipt of Cooperative Extension Class fees ($1,415); reduction of fund balance appropriation due to available funds from PCC donation contributions for Kirby Rebirth project (-$195,875); receipt of donation to Library ($815); changes to DSS intergovernmental grants ($79,107); receipt of donation to DSS for foster care assistance ($300). BA 1555 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Tax Adjustments for April 2015 Summary of Information: Attached please find the tax releases and motor vehicle pending refunds March 2015. 1. April 2015 tax releases. 2. April 2015 North Carolina Vehicle Tax System (NCVTS) pending refunds. Recommended Action: Motion to accept reports and authorize refunds. Submitted By: Russell Jones, Tax Administrator 56 COSSYS PERSON COUNTY TAX OFFICE COLLECTION SCROLL-12:LEVY ADJUSTMENTS ALL TAX YEARS 04132015 PAGE: 1 ACCOUNT # COLREC COUNTY-TAX DISTRICT DISTRICT DOG PENALTY INT/DISC LIEN-COST TOTAL NUMBER TRNREC CLRK DATE DISTRICT-" 39850 3022014 DAVENPORT DAVID ANTHONY LOT 36 WINSTEAD PK 39850 302 13436 -140.63 0.00- 0 0.00- 0 0.00 -14.06 0.00 0.00 -154.69 15410R 1670 CW 03062015 -132.59-50 -13.26 0.00 -145.85__________ -300.54 REASON:HE TURNED THE BOAT BACK IN & DID NOT OWN FOR 2014 57930 2012014 CAMPBELL LEILA HOBBS PERSONAL/BOAT 57930 201 37502 -7.41 0.00- 0 0.00- 0 0.00 -0.74 -0.28 0.00 -8.43 15411R 1674 CW 03132015 REASON:WAS SOLD MARCH 2013 53239 2012014 LONG MICHELLE & DAVID PERSONAL/BOATS 53239 201 39689 -13.16 0.00- 0 0.00- 0 0.00 -1.32 -0.51 0.00 -14.99 15412R 1675 CW 03172015 REASON:SOLD BOAT TO SHANNON HUFF FOR 2014 21683 1012014 BARKER KENNY BUSINESS PERSONAL 21683 101 41891 -17.85 0.00- 0 0.00- 0 0.00 -1.79 -0.69 0.00 -20.33 15413R 1680 RH 03182015 REASON:NEVER OPENED BUSINESS 60764 1132013 DEAN KIMBERLY TINGEN PERSONAL/BOAT 60764 113 56507 -18.76 0.00- 0 0.00- 0 0.00 -1.88 -2.51 0.00 -23.15 15414R 1700 CW 03302015 REASON:SOLD TO CHAD KENDRICK IN 2012 20273 1092009 CLAIBORNE MICHAEL L & SANDRA WILLOW LAKE/TR6/DW&L 20273 109 45219 -139.94 0.00- 0 0.00- 0 0.00 0.00 -15.75 0.00 -155.69 15212R 1701 BSG 03302015 REASON:BANKRUPTCY DISCHARGE 3/27/15 60764 2012014 DEAN KIMBERLY TINGEN PERSONAL/BOAT 60764 201 36617 -20.51 0.00- 0 0.00- 0 0.00 -2.05 -0.79 0.00 -23.35 15415R 1702 CW 03302015 REASON:SOLD BOAT TO CHAD KENDRICK FOR 2012 9317 1012014 J HARRIS WOODWORKS BUSINESS PERSONAL 9317 101 40826 -8.33 0.00- 0 0.00- 0 0.00 -0.83 -0.32 0.00 -9.48 15416R 1703 RH 03302015 REASON:BUSINESS CLOSED 99226 1042004 GARCIA JOSE WILMAN EAGLE TALON ESI 2S 99226 104 42129 -0.19 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.19 2004R 1704 SRJ 03302015 REASON:UNDER ONE DOLLAR 29688 1052005 CHRYSDSTOM ALDWYN LTD CROWN VICTORIA LX 2S 29688 105 42525 -0.04 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.04 2005R 1705 SRJ 03302015 REASON:UNDER ONE DOLLAR 46680 1062006 SHELLMAN JOHNY D LE SABRE CUSTOM 4S 46680 106 42830 -0.09 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.09 2006R 1706 SRJ 03302015 REASON:UNDER ONE DOLLAR 55041 1082008 ADAMS KEVIN JOSEPH CAMARO CP 55041 108 44218 -0.06 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.06 2008R 1707 SRJ 03302015 REASON:UNDER ONE DOLLAR 32664 1082008 BOWMAN ARON LEON CBR 1000 FL MC 32664 108 44206 -0.06 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.06 2008R 1708 SRJ 03302015 -0.12-50 0.00 0.00 -0.12__________ -0.18 REASON:UNDER ONE DOLLAR 25312 1082008 CHRISTOPHER MARILYN V PRIUS 4S 25312 108 44379 -0.04 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.04 2008R 1709 SRJ 03302015 -0.04-50 0.00 0.00 -0.04__________ -0.08 REASON:UNDER ONE DOLLAR 60259 1092009 ALLEN JOHN DEE PICKUP F100 1/2 TON TK 60259 109 44905 -0.03 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.03 2009R 1710 SRJ 03302015 REASON:UNDER ONE DOLLAR 56087 1092009 ANDERSON CHRISTOPHER RAYMOND PKUP RANGER 4X4 X CAB TK 56087 109 44745 -0.25 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.25 2009R 1711 SRJ 03302015 REASON:UNDER ONE DOLLAR 55605 1092009 HAWLEY GERALDINE CAMRY LE 4S 55605 109 44593 -0.08 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.08 2009R 1712 SRJ 03302015 -0.16-50 0.00 0.00 -0.16__________ -0.24 REASON:UNDER ONE DOLLAR 57 COSSYS PERSON COUNTY TAX OFFICE COLLECTION SCROLL-12:LEVY ADJUSTMENTS ALL TAX YEARS 04132015 PAGE: 2 ACCOUNT # COLREC COUNTY-TAX DISTRICT DISTRICT DOG PENALTY INT/DISC LIEN-COST TOTAL NUMBER TRNREC CLRK DATE DISTRICT-" 35373 1092009 LINDBLAD RUBIN LEE PICKUP S10 X CAB 1/2 TTK 35373 109 44618 -0.20 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.20 2009R 1713 SRJ 03302015 REASON:UNDER ONE DOLLAR 56625 1092009 PARRISH RUTH LEE NINETY EIGHT REGENCY E4S 56625 109 44900 -0.04 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.04 2009R 1714 SRJ 03302015 -0.12-50 0.00 0.00 -0.12__________ -0.16 REASON:UNDER ONE DOLLAR 58707 1112011 SMITH NAKISHA DENISE ALTIMA 4S 58707 111 48222 -0.68 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.68 2011R 1715 SRJ 03302015 REASON:UNDER ONE DOLLAR 8887 1122012 BLAINE CLARENCE FORRESTER III PICKUP C10/R10 1/2 TONTK 8887 112 51218 -0.58 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.58 2012R 1716 SRJ 03302015 REASON:UNDER ONE DOLLAR 61881 1122012 CARY IVORY EUGENE IMPALA 2S 61881 112 51317 -0.18 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.18 2012R 1717 SRJ 03302015 -0.30-50 0.00 0.00 -0.30__________ -0.48 REASON:UNDER ONE DOLLAR 16824 1122012 OBRIANT DAVID EVON JR CARAVAN SE VN 16824 112 51354 -0.35 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.35 2012R 1718 SRJ 03302015 -0.53-50 0.00 0.00 -0.53__________ -0.88 REASON:UNDER ONE DOLLAR 60209 1122012 PORTERFIELD ZACKERY JORDAN 4 RUNNER DLX MP 60209 112 51284 -0.70 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.70 2012R 1719 SRJ 03302015 REASON:UNDER ONE DOLLAR 10872 1132013 DILLON TAMMY LYNETTE 1 ACRE 10872 113 57758 -0.77 0.00- 0 -0.04-30 0.00 0.00 0.00 0.00 -0.81 2013R 1720 SRJ 03302015 REASON:UNDER ONE DOLLAR 59660 1132013 LOVELL SEAN MICHAEL OUTLANDER XLS 2WD MP 59660 113 56242 -0.59 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.59 2013R 1721 SRJ 03302015 REASON:UNDER ONE DOLLAR 55901 1132013 MARTIN AMY DAWN SW 55901 113 57102 -0.51 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.51 2013R 1722 SRJ 03302015 REASON:UNDER ONE DOLLAR 54221 1132013 THORNTON ABRAHAM LEE TC 2S 54221 113 55578 -0.59 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.59 2013R 1723 SRJ 03302015 REASON:UNDER ONE DOLLAR 41694 1132013 WOOD PHILLIP DANE JR 45 FT CT 41694 113 54915 -0.49 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.49 2013R 1724 SRJ 03302015 REASON:UNDER ONE DOLLAR 10713 3042014 BENNETT MARY B 5 ACRES/TRT 4 10713 304 26966 -0.13 0.00- 0 -0.01-30 0.00 0.00 0.00 0.00 -0.14 2014R 1725 SRJ 03302015 REASON:UNDER ONE DOLLAR 21430 3012014 CASE RICHARD & COLLEEN M CASE MT TIRZAH/LT21/VL 21430 301 18009 -0.82 0.00- 0 -0.07-30 0.00 0.00 0.00 0.00 -0.89 2014R 1726 SRJ 03302015 REASON:UNDER ONE DOLLAR 8972 1022014 CITY BARBER & BEAUTY SHOP BUSINESS PERSONAL 8972 102 36848 -0.07 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.07 2014R 1727 SRJ 03302015 -0.07-50 0.00 0.00 -0.07__________ -0.14 REASON:UNDER ONE DOLLAR 8972 1022014 CITY BRIDAL & GIFT SHOP BUSINESS PERSONAL 8972 102 35155 -0.04 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.04 2014R 1728 SRJ 03302015 -0.04-50 0.00 0.00 -0.04__________ -0.08 REASON:UNDER ONE DOLLAR 26962 3012014 EVANS JUSTIN BRIARWOOD/LT8/H&L 26962 301 11212 -0.04 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.04 2014R 1729 SRJ 03302015 -0.04-50 0.00 0.00 -0.04__________ -0.08 58 COSSYS PERSON COUNTY TAX OFFICE COLLECTION SCROLL-12:LEVY ADJUSTMENTS ALL TAX YEARS 04132015 PAGE: 3 ACCOUNT # COLREC COUNTY-TAX DISTRICT DISTRICT DOG PENALTY INT/DISC LIEN-COST TOTAL NUMBER TRNREC CLRK DATE DISTRICT-" 13942 9012014 FAITH CHRISTIAN CHURCH INC RELIGIOUS 13942 901 15001 0.00 0.00- 0 -0.12-30 0.00 0.00 0.00 0.00 -0.12 2014R 1730 SRJ 03302015 REASON:UNDER ONE DOLLAR 54550 1012014 KOZAR HEATING & AIR BUSINESS PERSONAL 54550 101 40951 -0.66 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.66 2014R 1731 SRJ 03302015 REASON:UNDER ONE DOLLAR 43272 9012014 NC STATE UNIV ENDOWMENT FUND 2 & 7/100 ACRES VACANT 43272 901 4037 0.00 0.00- 0 -0.04-30 0.00 0.00 0.00 0.00 -0.04 2014R 1732 SRJ 03302015 REASON:UNDER ONE DOLLAR 43272 9022014 NC STATE UNIV ENDOWMENT FUND 97 & 73/100 ACRES 43272 902 4036 0.00 0.00- 0 -0.06-30 0.00 0.00 0.00 0.00 -0.06 2014R 1733 SRJ 03302015 REASON:UNDER ONE DOLLAR 3344 3012014 QUALLS SAMMIE E FOREST SHRS/PA/T1/H&L 3344 301 2148 -0.29 0.00- 0 -0.01-30 0.00 0.00 0.00 0.00 -0.30 2014R 1734 SRJ 03302015 REASON:UNDER ONE DOLLAR 46618 1012014 TAMMYS UNBELIEVABLES BUSINESS PERSONAL 46618 101 41369 -0.01 0.00- 0 0.00- 0 0.00 0.00 0.00 0.00 -0.01 2014R 1735 SRJ 03302015 -0.02-50 0.00 0.00 -0.02__________ -0.03 REASON:UNDER ONE DOLLAR 59 COSSYS PERSON COUNTY TAX OFFICE COLLECTION SCROLL-12:LEVY ADJUSTMENTS ALL TAX YEARS 04132015 PAGE: 4 TRANSACTION TOTALS PAGE TRANSACTIONS FROM 1 THROUGH 1759 IN SY0:TAX .MOD AMOUNTS FROM -999999999.99 THROUGH 999999999.99TRANSACTION TYPES:R TRANSACTIONS 03062015->04102015 0 PAYMENTS 0 DISC/CORR 40 RELEASES TOTAL CREDIT NET CREDIT (PAYMENT+RELEASE) (TOTAL-DISC/CORR)PERSON COUNTY TAX OFFICE 0.00 0.00 -375.17 375.17 375.17LATE LISTING 0.00 0.00 -22.67 22.67 22.67 DOG 0.00 0.00 0.00 0.00 0.00 CODE DISTRICT NAME 30 STORMWATER FEE 0.00 0.00 -0.35 0.35 0.35 --------------- --------------- --------------- --------------- --------------- SUB-TOTAL 0.00 0.00 -398.19 398.19 398.19 STATE 3PCT INTEREST 0.00 0.00 0.00 0.00 0.00 DISCOUNT 0.00 0.00 0.00 0.00 0.00INTEREST 0.00 0.00 -20.85 20.85 20.85LIEN SALE COST 0.00 0.00 0.00 0.00 0.00 --------------- --------------- --------------- --------------- --------------- TOTAL 0.00 0.00 -419.04 419.04 419.04 50 CITY OF ROXBORO 0.00 0.00 -134.03 134.03 134.03LATE LISTING 0.00 0.00 -13.26 13.26 13.26 --------------- --------------- --------------- --------------- --------------- SUB-TOTAL 0.00 0.00 -147.29 147.29 147.29 DISCOUNT 0.00 0.00 0.00 0.00 0.00INTEREST 0.00 0.00 0.00 0.00 0.00 --------------- --------------- --------------- --------------- --------------- TOTAL 0.00 0.00 -147.29 147.29 147.29 TOTAL TAXES 0.00 0.00 -545.48 545.48 545.48TOTAL LIEN COST 0.00 0.00 0.00 0.00 0.00TOTAL DISCOUNT 0.00 0.00 0.00 0.00 0.00 TOTAL INTEREST 0.00 0.00 -20.85 20.85 20.85 TOTAL STATE 3PCT INTEREST 0.00 0.00 0.00 0.00 0.00 =============== =============== =============== =============== =============== GRAND TOTAL 0.00 0.00 -566.33 566.33 566.33 60 Payee Name Address 3Bill # Refund ReasonCreate DateTax Jurisdiction Levy Type Change Interest Change Total Change01Tax ($50.04)$0.00 ($50.04)Refund $50.0401Tax($5.17)$0.00 ($5.17)50Tax ($4.66)$0.00 ($4.66)50 Vehicle Fee $0.00$0.00$0.00Refund$9.8301Tax ($4.32)$0.00 ($4.32)Refund$4.3201Tax ($5.11)$0.00 ($5.11)Refund$5.1101Tax ($13.12)$0.00 ($13.12)Refund $13.1201Tax$0.00$0.00$0.0050Tax ($29.83)$0.00 ($29.83)50 Vehicle Fee ($10.00)$0.00 ($10.00)Refund $39.8301Tax ($26.72)$0.00 ($26.72)Refund $26.7201Tax ($8.34)$0.00 ($8.34)50Tax ($7.87)$0.00 ($7.87)50 Vehicle Fee $0.00$0.00$0.00Refund $16.2101Tax ($30.67)$0.00 ($30.67)Refund $30.6701Tax ($11.15)$0.00 ($11.15)Refund $11.1501Tax ($55.96) ($3.22) ($59.18)Refund $59.1801Tax ($29.07)$0.00 ($29.07)Refund $29.0701Tax ($3.98)$0.00 ($3.98)Refund$3.98MEDLIN, JUDY HURDLE MILLS, NC 27541Proration 0016182713 Vehicle Sold 03/16/2015MANGAN, MARTIN OXFORD, NC 27565Proration 0024294802 Vehicle Sold 04/06/2015Insurance Lapse04/07/20150021004578KEY, MAGGIE JACKSONVILLE, NC 27541ProrationJONES, KEVIN ROXBORO, NC 27574Adjustment < $1000024998424 Mileage 03/17/2015FLEMING, ALAN TIMBERLAKE, NC 27583Proration 0022899011 Vehicle Sold 04/07/2015DUNN, WILLIAM ROXBORO, NC 27573Proration 0016183337 Vehicle Sold 04/02/2015Vehicle Sold 03/25/20150005948497DETWILER, JOHN TIMBERLAKE, NC 27583ProrationSitus error 03/12/20150024644235COOPER, TERESA CEDAR GROVE, NC 27231Adjustment < $100COLEMAN, JAMES ROXBORO, NC 27574Proration 0016171930 Vehicle Sold 04/08/2015CARPENTER, JAMES TIMBERLAKE, NC 27583Proration 0009372399 Vehicle Sold 04/06/2015CAO, LAN ROUGEMONT, NC 27572Proration 0005932412 Vehicle Sold 03/23/2015BENSON, RONALD ROXBORO, NC 27573Proration 0016169273 Reg . Out of state03/16/2015ANDERS, DUSTIN ROXBORO, NC 27574Proration 0024678303 Vehicle Sold 03/17/2015Refund Type61 Payee Name Address 3Bill # Refund ReasonCreate DateTax Jurisdiction Levy Type Change Interest Change Total ChangeRefund Type01Tax ($8.35)$0.00 ($8.35)Refund$8.3501Tax ($49.87)$0.00 ($49.87)Refund $49.8701Tax ($19.53)$0.00 ($19.53)50Tax ($18.41)$0.00 ($18.41)50 Vehicle Fee $0.00$0.00$0.00Refund $37.9401Tax ($28.75)$0.00 ($28.75)Refund $28.7501Tax ($84.25)$0.00 ($84.25)Refund $84.2501Tax$0.00$0.00$0.0050Tax ($16.50)$0.00 ($16.50)50 Vehicle Fee ($10.00)$0.00 ($10.00)Refund $26.5001Tax ($112.80)$0.00 ($112.80)Refund $112.8001Tax ($35.97)$0.00 ($35.97)50Tax ($33.92)$0.00 ($33.92)50 Vehicle Fee ($10.00)$0.00 ($10.00)Refund $79.8901Tax ($26.46) ($1.52) ($27.98)Refund $27.9801Tax ($31.50)$0.00 ($31.50)Refund $31.5001Tax ($29.27)$0.00 ($29.27)Refund $29.2701Tax ($275.50) ($15.84) ($291.34)Refund $291.3401Tax ($13.38)$0.00 ($13.38)Refund $13.3801Tax ($24.09)$0.00 ($24.09)Refund $24.0901Tax ($1.60)$0.00 ($1.60)Refund$1.6001Tax ($82.51)$0.00 ($82.51)Refund $82.51Vehicle Sold 03/12/20150021464165WALL, LEWIS ROXBORO, NC 27573ProrationWADE, ROBERT ROXBORO, NC 27573Proration 0020257879 Vehicle Sold 03/10/2015Adjustment 03/17/20150025082534VALENTINE, CHRISTOPHER ROXBORO, NC 27574Adjustment < $100VALENTINE, CHRISTOPHER ROXBORO, NC 27574Adjustment < $1000023609652 Adjustment 03/17/2015Mileage 03/11/2015SWEET, ERIC TIMBERLAKE, NC 27583Adjustment >= $1000024284902 Military 03/06/20150019337255SWANN, THEODORE CREEDMOOR, NC 27522Adjustment < $100Over Assessment03/24/20150024979933SPERRY, PAUL DURHAM, NC 27704Adjustment < $100Situs error 03/11/2015RICHMOND, TONY HURDLE MILLS, NC 27541Proration 0021056820 Vehicle Sold 03/16/20150022498845RICHMOND, SHERRY ROUGEMONT, NC 27572Adjustment < $100PRICE, MICHAEL ROXBORO, NC 27574Proration 0023142797 Vehicle Sold 03/18/2015PRESERVE HOLDING COMPANY,INC CEDAR GROVE, NC 27231Adjustment < $1000024967054 Situs error 03/12/2015PAUL, WILLIAM ROXBORO, NC 27574Proration 0008508557 Tag Surrender03/09/2015Tag Surrender04/02/2015PARKER, LISA TIMBERLAKE, NC 27583Proration 0016179875 Vehicle Sold 03/10/20150023028306PARADIS, JAMES ROXBORO, NC 27573ProrationMONTOYA, NICHOLAS ROUGEMONT, NC 27572Proration 0024066772 Vehicle Sold 03/16/2015MEDLIN, THOMAS HURDLE MILLS, NC 27541Proration 0019110704 Tag Surrender03/16/201562 Payee Name Address 3Bill # Refund ReasonCreate DateTax Jurisdiction Levy Type Change Interest Change Total ChangeRefund Type01Tax ($49.02)$0.00 ($49.02)Refund $49.0201Tax ($14.42)$0.00 ($14.42)Refund $14.4201Tax ($6.86)$0.00 ($6.86)Refund$6.8601Tax ($31.97)$0.00 ($31.97)Refund $31.9701Tax ($3.50)$0.00 ($3.50)Refund$3.5001Tax ($46.41) ($2.32) ($48.73)Refund $48.73Vehicle Sold 03/30/20150005966286WOODS, GLORIA HURDLE MILLS, NC 27541ProrationWILSON, ROBERT TIMBERLAKE, NC 27583Proration 0005960816 Vehicle Sold 03/27/2015WILSON, ROBERT TIMBERLAKE, NC 27583Proration 0019105559 Vehicle Sold 03/27/2015Over Assessment04/06/20150025460639WILKERSON, DONALD ROXBORO, NC 27574Adjustment < $100WILKERSON, DONALD ROXBORO, NC 27574Adjustment < $1000025460495 Over Assessment04/06/2015WEST, RONNIE ROXBORO, NC 27574Proration 0016168355 Vehicle Sold 03/09/201563 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Person County JCPC Funding Recommendations for FY2015-2016 Summary of Information: Each year, funding is made available through the North Carolina Department of Public Safety / Division of Juvenile Justice to Person County and its Juvenile Crime Prevention Council (JCPC) to be utilized to address the needs of youth at-risk for delinquency as well as adjudicated undisciplined and delinquent youth in Person County. The funding comes in the form of a county allocation. All 100 counties in the State of North Carolina are allocated funds based on the population of youth in the county between the ages of 10 and 17. Person County will receive $123,213 in its allocation from the North Carolina Department of Juvenile Justice and Delinquency Prevention in FY16. Annually, the JCPC Board conducts a planning process, which includes an array of legislated tasks: a review of the community risk factors and the risk levels of youth in the community; an assessment of the needs of the target populations; a review of the service resources available to address those needs; the identification of service gaps; and the strategic development of a plan to structure a seamless continuum of service programming to address the target population needs. As part of the development of the needed services identified in the continuum, there is a Request for Proposal (RFP) process that is completed by the JCPC Board. Non-profits and government entities may apply for the opportunity to provide services per the guidelines of the RFP. The JCPC Board reviews all requests and awards are made to service providers to address service needs identified by the JCPC Board. The JCPC Board makes its recommendation of expenditures of the allocation and presents its written annual planning documents to the Person County Board of County Commissioners for its approval. The JCPC Board performs this function as an extension of the Board of County Commissioners in its fulfillment of the legislated duties imposed upon them through general statute. Additionally, on an on-going basis, the JCPC evaluates the performance of its funded programs by annually monitoring each program through on-site visits and also monthly through program reporting at the local, monthly JCPC meetings. The JCPC is also charged with the tasks of increasing public awareness of the causes of delinquency, addressing strategies to intervene and appropriately responding to and treating the needs of juveniles while at the same time reducing juvenile recidivism. The JCPC stands ready to respond to the changing needs of youth and service delivery in the community. Recommended Action: The Person County Juvenile Crime Prevention Council met on April 8, 2015 and voted to approve the DJJ allocation to be distributed in the following manner for the 2015-2016 fiscal year with a specific alternate request that if the Person County Board of Commissioners chooses not to fund any one program provider that the remaining request be granted and divided between all other program providers as determined by the Person County Juvenile Crime Prevention Council. 64 2014-2015 Recommendation from Person County JCPC Council Program DJJDP Funds County Cash Requested 4-H YES $ 90,000 $23,307* Roots & Wings Parenting Program 12,000 0 Roots & Wings Mentoring Program 8,000 0 G.R.E.A.T. Program (Sheriff’s Dept) 0 0 Central Children’s Home 0 0 Administrative Fund 13,213 0 Total $123,213 $23,307 *Required 20% county match; 20% match is calculated after administrative funds are removed 2015-2016 Recommendation from Person County JCPC Council Program DJJDP Funds County Cash Requested 4-H YES $ 91,764 $23,543* Roots & Wings Parenting Program 12,000 0 Roots & Wings Mentoring Program 11,000 0 Administrative Fund 5,500 0 Unallocated to go to programs 2,949 0 Total $123,213 $23,543 *Required 20% county match; 20% match is calculated after administrative funds are removed Submitted By: John Hill, JCPC Chairperson 65 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Radio, Telephone and TV Transmitting Tower Setback Language Background: On April 6, 2015, the Person County Commissioners voted unanimously to repeal the Person County Wireless Telecommunications Facilities Ordinance; to add Radio, Telephone and TV Transmitting Towers to the B1 and B2 Zoning Districts; to allow these as a use-by-right unless adjacent to a residential use or if located in the R or RC Zoning District; and, to add a Note to the Table of Permitted Uses about setbacks. Summary of Information: 1.) The Person County Planning Ordinance Table of Permitted Uses has been amended, as follows: A.) Includes Radio, Telephone and TV Transmitting Towers as a Use-by-Right in GI, B1, and B2 Zoning Districts unless adjacent to a residential use, in which case, a Special Use Permit is required. A Special Use Permit is also required for towers in R and RC Zoning Districts. B.) Includes in “Note 9” of the Table of Permitted Uses: Towers located in B1, B2 or GI Districts require a Special Use Permit if located adjacent to a residential use. Setbacks for Radio, Telephone and TV Transmitting Towers will be equal to the height of the tower unless the fall-zone is certified to be less than the height of the tower. At a minimum, towers in all Districts are subject to the standards of the Table of Dimensional Requirements (Table 75; page 64). Tower applicants must provide proof of compliance with State and Federal regulations. 2.) The “Lattice Tower” is sometimes referred to as "self-supporting” or SST because it is a free- standing, tapered, tower. It typically stands 200-400 ft. tall with a triangular base and three sides constructed in three or more sections with “break points” at each section. Because the structure is designed with break points at each section, the fall zone for this specific type of tower is less than others. Staff recommends adding to “Note 9”: Lattice towers, or self-supporting towers, with a triangular base tapered to the top and engineered with break-points may be setback a distance ½ their height. Recommended Action: Approve language Submitted By: Michael Ciriello, Planning Director 66 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Solid Waste Management Study RFP and environmental testing results from the Upper Piedmont Environmental Landfill Summary of Information: At the March 2nd BOC meeting, the Board asked staff to gather information regarding environmental testing at the Upper Piedmont Environmental landfill. The Commissioners expressed interest in better understanding the water and air quality testing systems before determining whether or not to move forward with a Solid Waste Management Study RFP. Staff met with a representative from NCDENR to discuss these systems and has asked experts from the NCDENR Division of Waste Management and the Division of Air Quality to present the requested information. The BOC also requested information regarding the health impacts that the landfill has on nearby residents. The Person County Health Director contacted the State’s Department of Health and Human Services to request information regarding the rate of cancer cases in Person County. According to the State and the Person County Health Director, “Our rates are similar to the State rates, and there are ‘no consistent pattern of cases’; ‘we do not see a higher occurrence of cancers in the populations usually associated with environmental factors at this time or any evidence of clustering of cancer cases in any of these areas.’” Attached are the documents from the State and the Person County Health Director regarding cancer rates in Person County. The scope of the RFP contains the following (attached is a copy of the RFP): 1. Cost-benefit analysis of solid waste management options 2. Recommend an option based on cost and service quality 3. Cost-benefit impact of each option on the City of Roxboro 4. Recommend sites for landfill, transfer stations and collection sites; include zoning recommendation 5. Analysis of environmental testing at current landfill; pre and post-testing 6. Analysis of current landfill capacity; analysis of landfill waste stream 7. Review current recycling system and recommend appropriate changes that will increase recycling. Recommendations for increasing recycling in our future waste management system. Include cost estimates and anticipated revenues. 8. Assist and/or lead negotiations with Republic, if contract renewal is outcome Recommended Action: Provide staff with feedback about which items should be included in the RFP. Submitted By: Sybil Tate, Assistant County Manager 67 4/13/2015 1 Person County Request for Proposals (RFP) Solid Waste Management Study March 2, 2015 68 4/13/2015 2 1. Project Overview Person County, North Carolina is seeking proposals from qualified firms to perform a comprehensive solid waste study. The county has identified major areas of research that the final study must include. They are the following: 1. Cost-benefit analysis of solid waste management options 2. Recommend an option based on cost and service quality 3. Cost-benefit impact of each option on the City of Roxboro 4. Recommend sites for landfill, transfer stations and collection sites; include zoning recommendation 5. Analysis of environmental testing at current landfill; pre and post-testing 6. Analysis of current landfill capacity; analysis of landfill waste stream 7. Review current recycling system and recommend appropriate changes that will increase recycling. Recommendations for increasing recycling in our future waste management system. Include cost estimates and anticipated revenues. 8. Assist and/or lead negotiations with Republic, if contract renewal is outcome Attached is a memo that contains the solid waste management options shared with the Person County Board of Commissioners at their Feb. 16, 2015 meeting. 2. Background Person County is a rural county with a population of almost 40,000 residents. The City of Roxboro is the only municipality and has a population of 8,344. The county provides recycling services at a single drop-off point in the City of Roxboro, but it does not provide any other solid waste management services, such as collection, collection sites, or disposal services. The county contracts with Republic Services for disposal services and private haulers operate collection services in the unincorporated areas of the county. Individuals who do not wish to pay a private hauler may take their waste directly to the landfill. The City of Roxboro provides collection services through its Solid Waste department and pays a tipping fee to deliver the waste to Republic’s landfill. Republic Services owns and operates the Upper Piedmont Environmental Landfill; however, the contract and franchise agreement between Republic and the County expires on August 7, 2017. Currently, the county receives an estimated $530,000/yr in host fee revenues, an additional $25,000/yr in funding for promoting recycling and $30,214/yr in tax revenues. 3. Proposal Requirements Interested firms shall submit a proposal consisting of the following information, tabbed as identified and in the order indicated below: Section 1 – General Introduction (maximum of two (2) pages) Provide a general introduction of your firm to include, but not be limited to, firm name, year established, address, telephone number, fax number and contact person. Section 2 – Personnel 69 4/13/2015 3 Specify professional qualifications of key management and staff personnel to be assigned to the project. Identify specialty, level of expertise, education and any direct work experience on projects similar in scope to the one being proposed. For the proposed project manager, provide the name and phone number of two (2) clients with whom the project manager has worked on similar projects to include the following information: • Client name/type (private sector and/or government) • Reference name and current contact information (phone and e-mail) Section 3 – Consultants/Sub-consultants/Other Participants Provide a list of consultants and/or sub-consultants, if any, who would be retained to provide services on the project including qualifications and experience of all listed. Highlight any unique experience relative to this type or scope of work. Specify the percentage of work anticipated to be attributed to these consultants. Identify any Disadvantaged Business Enterprise (DBE), minority, or local firms to be used. Section 4 – Past Experience Provide a range of projects that most closely compare to the areas of concentration described in the Project Overview section of this RFP. Describe the precise involvement that your firm had in each of the cited examples to include, but not be limited to, the following: • A brief description of each project with status and outcome • Examples of challenges you encountered when implementing projects of this nature and the ensuing resolutions/decisions Provide names and contact numbers for cited projects. Section 5 – Project Approach and Timeline Based on the project scope and objectives provided herein, describe the specific services and activities your firm proposes to provide, identify key staff assignments for each, and outline required actions/involvement by County personnel. Provide a general schedule indicating the approximate amount of time required to complete the various stages of the project. Describe any unique qualities or experience you feel make your firm best suited to perform this work. Section 6 – Fee Proposal The fee proposal shall include a total fee for each component outlined in the proposal with a not-to-exceed amount and hourly rates charged for team members, which may be used to negotiate changes in the scope of work if necessary. 70 4/13/2015 4 4. Selection Criteria for Completeness Proposals will be reviewed to ensure that the proposals is received on time (March 23, 2015; 5:00 PM), is substantially complete and meets other eligibility requirements. If these standards are not met, the proposal will be rejected. Proposals will not be returned to the applicant. (1) Timeliness. Proposals will be reviewed to verify submission by the submission deadline. Person County will reject Proposals that do not meet the submission deadline. (2) Completeness. Proposals will be reviewed to verify completeness. All items in Section 3 must be addressed. Person County will reject Proposals that do not address all items in these sections and are thus materially incomplete. (3) Quality of Personnel. Proposals will be reviewed to ensure that the project personnel are qualified to complete the study. (4) Quality of References. All proposals will be verified with reference checks from previous customers. 5. Evaluation Criteria and Process Proposals deemed complete will be reviewed, and scored in the following areas. Scoring Factor Criteria Max Points Ability to complete the project A. Knowledge of key study requirements B. Includes a well thought-out and realistic project implementation timeline C. Quality of project approach description 25 Capacity to complete the project A. Staff capacity and experience, relevant job descriptions 25 Past Experience A. Depth of past/current experience B. Quality of references 25 Cost A. Total project costs B. Breakdown of component costs 25 Scores for each rating factor will be added together to obtain a total score for each proposal. Proposals will then be ranked from highest to lowest according to the total combined score. Person County may choose a single vendor or multiple vendors. Person County reserves the right to reject all proposals. 6. Award Schedule March 2, 2015 Request for Proposals released by Person County March 9, 2015 Questions from vendors due to Person County March 23, 2015 Proposals due to Person County 71 4/13/2015 5 March 24 –April 20, 2015 Review and recommendations April 2015 Projected Date for award notification The schedule is subject to change without notice. 7. Proposal Submission Process One electronic copy of this Proposal, and all relevant materials, must be received by 5:00 PM on the deadline date. Faxes are not acceptable. The electronic copy should be submitted by e-mail. When submitting materials by e-mail, you must have a reply from Person County acknowledging receipt of materials. Please send submissions to state@personcounty.net. 8. Corrections to Deficient Proposals After the Proposal due date, no unsolicited information will be considered. However, Person County staff may contact the applicant to correct non-substantive deficiencies. In each case of a completeness deficiency, the applicant will be notified by telephone or email documenting the deficiency. All supplemental information requested by the County must be received within five business days of the date of notice or the proposal will be rejected. 9. Questions Person County will respond to questions submitted ONLY via e-mail to state@personcounty.net. The deadline for questions is 5:00 PM, March 9, 2015. The questions will be answered to the submitter and all questions and responses will be posted on the Person County website. 10. Miscellaneous Requirements Consultant agrees to hold harmless and indemnify County from any and all claims, loss, liability, demands, damages or any other financial demands that may be alleged or realized due to acts of nonfeasance, malfeasance, misfeasance, or negligence committed by Consultant while in the performance of the duties or assignment pursuant to this Agreement. Consultant agrees to procure and maintain, or cause to be procured and maintained, commercial general liability insurance with liability limits of at least one million dollars ($1,000,000.00) per occurrence and two million dollars ($2,000,000.00) aggregate; Consultant shall also procure and maintain, or cause to be procured and maintained, Workers’ Compensation coverage for its employees, as may be required by law and Errors and Omission insurance in the amount of at least $1,000,000.00. Consultant’s certificate of insurance shall be furnished to the County and shall give the County a 30 day written notice of any changes, amendments or termination by either the Consultant or insurance company. Person County’s policy is to provide and encourage minority business the opportunity to participate in the bidding process. Person County does not discriminate against any persons or business in pursuit of these opportunities on the basis of color, national origin, religion, sex, age, disability, or veteran’s status. 72 4/13/2015 6 11. Certification by Applicant The attached statements and exhibits are hereby made part of this Proposal and the undersigned representative of the applicant certifies that the information in this Proposal and the attached statements and exhibits is true, correct and complete to the best of his/her knowledge and belief. He/She further certifies that: 1. As authorized representative, he/she has been authorized to file this Proposal by formal action of the governing body; 2. That the governing body agrees that if a contract from the Person County is awarded, the applicant will provide proper and timely submittals of all documentation requested by the County; 3. That the applicant has substantially complied with or will comply with all federal, state and local laws, rules and regulations and ordinances as applicable to the project. ______________________________________________________________________ Signature of Grantee/Authorized Representative Typed Name and Title Date Checklist for Additional Forms: Please enclose the additional items before submitting: Project Proposal (see proposal requirements) 73 North Carolina Department of Health and Human Services Division of Public Health Pat McCrory Aldona Z. Wos, M.D. Governor Ambassador (Ret.) Secretary Secretary DHHS Daniel Stanley Acting Division Director www.ncdhhs.gov • www.publichealth.nc.gov Tel 919-707-5000 • Fax 919-870-4829 Location: 5605 Six Forks Road • Raleigh, NC 27609 Mailing Address: 1931 Mail Service Center • Raleigh, NC 27699-1931 An Equal Opportunity / Affirmative Action Employer April 1, 2015 Dear Director Clayton, Thank you for your inquiry to the Central Cancer Registry regarding cancer cases in Person County. We receive many requests such as yours for information about cancers in local areas throughout the state. The Central Cancer Registry compiles information on cancers across North Carolina and we monitor cancer rates for many types of cancer for each county annually to see if there appear to be areas of the state that need special attention. Although much has been learned about cancer over the past couple of decades, there is still much that is not known about the causes of cancer. What we do know is that cancer is not one disease, but a group of diseases that behave similarly. We know that different types of cancers are caused by different things. For example, cigarette smoking has been implicated in causing lung cancer, some chemical exposures are associated with leukemia, and prolonged exposure to sunlight causes some types of skin cancer. Genetic research has shown that defects in certain genes result in a much higher likelihood that a person will get cancer. What is not known is how genetic factors and exposures to cancer causing agents interact. Many people do not realize how common cancers are. It is estimated that one out of every two men and one out of every three women will develop a cancer of some type during his or her lifetime. As a result, it is common to find what appear to be cancer cases clustering in neighborhoods over a period of years. This will occur in any neighborhood. As people age, their chance of getting cancer increases, and so as we look at a community, it is common to see increasing numbers of cancer cases as the people in the community age. Cancers are diseases that develop over many years. As a result, it is difficult to know when any specific cancer began to develop, and consequently, what the specific factor was which caused the cancer. Because people in our society move several times during their lives, the evaluation of clusters of cancer cases is quite challenging. One can never be certain that a specific cancer was caused by something in the community in which the person currently resides. When clusters of cancer cases are investigated, we look for several things that are clues to likely associations with exposures in the community. These are: 1. Groups of cases of all the same type of cancer (such as brain cancer or leukemia). Because different things cause different types of cancer, cases of many different types of cancer do not constitute a cluster of cases. 2. Groups of cases among children, or ones with an unusual age distribution. 3. Cases diagnosed during a relatively short time interval. Cases diagnosed over a span of years do not constitute a cluster of cases unless there is consistency in the type of cancer. 4. Clusters of rare cancers. Because lung, breast, colon, and prostate cancers are so common, it is very difficult to find any association between them and exposures in a community. This report is updated based on cases reported to the North Carolina Central Cancer Registry (CCR) as of February 2015, diagnosed during 1990 - 2014, address at the time of diagnosis in North Carolina and diagnosis codes as reflected in the pathology and medical reports reported from the hospitals and facilities. Further, cases diagnosed out of the state and country but may be receiving treatment in facilities in North Carolina are not included as they are not required to be reported. The CCR does not have real time data because it takes hospitals at least six months after the diagnosis of a malignancy to submit cancer diagnosis reports. The reason for this is that, per General Statute 130A-209, CCR requires facilities to report complete first course of treatment data and many cases have an extended period of first course treatment. The patient may have surgery, followed by multiple courses of chemotherapy, followed by 74 radiation therapy. In order to obtain complete and accurate data from the facilities there is a lag time of at least six months. For some cases, CCR receives multiple reports from different facilities, which are reviewed and consolidated on an ongoing basis. CCR continues to receive reports from the hospitals for cases diagnosed in 2013, 2014 and prior years. Therefore, all cases diagnosed in 2013 and 2014 may not be included in this report. In order to evaluate the cancer risk in the county requested, all of the cases of cancer in our database diagnosed from 1990 to 2014 were identified. During this time a total of 4,536 cancer cases were diagnosed in Person County. Across the county, the four major cancers - female breast, colon/rectum, prostate, and lung - comprised 57 percent of the cases. Pediatric cancers comprised less than 1 percent of the total number of cases and 86 percent of the cases were age 50 or older, when cancer diagnoses are quite common. These cases were spread out over the 25 years, not concentrated in a short time period. Further, we examined the age-adjusted cancer incidence rates in Person County for the 2008-2012 diagnosis years and found that the rates for colorectal, lung/bronchus, female breast and prostate cancers were similar to the state rates. Overall there were 1,205 cases reported in Person County for this five year period. In addition, we looked at cancers that have been shown to be associated with environmental risk factors (liver, pancreas, leukemia, brain, bladder, kidney, multiple myeloma and non-Hodgkin lymphoma) and identified a total of 863 cases for Person County between 1990 and 2014. These cases were spread out over the 25 years and not concentrated in any time period. Concern was also expressed over the incidence of lung/bronchus and brain/other CNS cancers in Person County. Between 1990 and 2014, there were 753 cases (or about 17 percent of all cancer cases) of lung/bronchus cancer and 66 cases (about 2 percent of all cases) of brain/other CNS cancer in Person County while there were 150,429 cases (or about 15 percent of all cancer cases) of lung/bronchus cancer and 13,363 cases (or about 1 percent of all cases) of brain/other CNS cancer statewide. Further analysis of the age-adjusted cancer incidence rates in Person County for the 2008-2012 diagnosis years showed that the rates for lung/bronchus and brain/other CNS cancers were similar to the state rates. Overall, no consistent pattern of cases was observed other than those previously stated. It is possible that there is an environmental risk for cancer in the area; however, we do not see a higher occurrence of cancers in the populations usually associated with environmental factors at this time or any evidence of a clustering of cancer cases in any of these areas. On the CCR website (www.schs.state.nc.us/SCHS/data/cancer.cfm), there is additional North Carolina cancer information, including the NC Cancer Profile and the Cancer Profile for Person County. There are also fact sheets regarding the leading cancers in the state. If you have questions regarding any of this information or you want additional resources about cancer, please do not hesitate to contact me at Gary.YH.Leung@dhhs.nc.gov or (919) 715-4559. At the request of the North Carolina Senate, House of Representatives and local health departments, copies of neighborhood cancer evaluations are also sent to those who represent and serve the area of the state being evaluated, as well as the Occupational and Environmental Epidemiology Branch at the Division of Public Health. Sincerely, Gary Leung, PhD. N.C. Department of Health and Human Services Statistician, North Carolina Central Cancer Registry, Division of Public Health 222 N. Dawson Street, Cotton Classing Building, Raleigh, NC 27603 (Office) 919-715-4559 Gary.YH.Leung@dhhs.nc.gov http://www.schs.state.nc.us/schs/data/cancer.cfm CC: Representative Larry Yarborough Senator Mike Woodard Janet Clayton, Person County Health Department Dr. Rick Langley, MD, MPH, Occupational and Environmental Epidemiology Branch 75 76 77 AGENDA ABSTRACT Meeting date: April 20, 2015 Agenda Title: Duke Energy Progress Neighborhood Energy Saver Program Summary of Information: Duke Energy Progress is offering their Neighborhood Energy Saver Program to the residents in Roxboro. This program offers free energy-saving home improvements to selected communities. Duke Energy Progress chooses communities where the program would be most beneficial by targeting low-income neighborhoods. Energy specialists offer walk-through assessments of homes identifying opportunities for energy savings. Based upon the needs of the home, customers can then receive up to $210 in energy-saving improvements. These improvements and their installation are free. Another component of the program is energy education. Each resident receives education on techniques and behaviors to help reduce and control energy use. A list of available energy- saving measures is provided on the enclosed handout. The kickoff for this program will be on May 14th. Recommended Action: Receive the information. Submitted By: Evans Taylor, Duke Energy Neighborhood Energy Saver Program Administrator 78 79 80 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Resolution requesting Abandonment of a portion of Secondary Road 1401 Summary of Information: Poindexter Property Management, LLC has submitted the attached petition requesting the Board of Transportation to abandon a portion of Secondary Road 1401 from the state maintained system. Recommended Action: The Board of Commissioners to adopt a Resolution requesting abandonment of a portion of Secondary Road 1401. Submitted By: Alan Hicks, Attorney for Poindexter Property Management 81 82 83 84 85 AGENDA ABSTRACT Meeting date: April 20, 2015 Agenda Title: Volunteer Fire Departments and Rescue Audits Summary of Information: To strengthen reporting accountability and ensure appropriate use of County funds for the Rescue Squad and Volunteer Fire Departments (“agencies”), it is recommended that these funded departments produce a current financial audit for FY 2013-2014, and each year thereafter, as a conditional requirement before their next year’s funding allocation is distributed. The cost quoted by the County’s current auditor in their recent proposal is $2,750 for each agency’s audit. There are a total of 9 agencies, so the total estimate for all audits to be performed is $24,750. Some funding options for discussion include: Agency-funded only • Agencies contract directly with an audit firm of their choice: pays cost from their existing funds. No County funding necessary in this option. County-funded only • County approves contract with current audit firm, appropriates funds from the current year (Fund Balance or Contingency) with no reduction of agencies’ future funding • County approves contract with current audit firm, appropriates funds from the current year (Fund Balance or Contingency), then transfers funds from existing monies in the Revolving Loan Fund back to the General Fund County/Agency-funded • Agencies contract directly with an audit firm of their choice: sends invoices to County to pay, then County deducts from each department’s funding allotment for FY 2016 • County approves contract with current audit firm, appropriates funds from the current year (Fund Balance or Contingency), then deducts payment from each department’s funding allotment for FY 2016 Recommended Action: Approve a funding option that provides the County with the ability to receive audited financial statements from the Rescue Squad and Volunteer Fire Departments. Submitted By: Heidi York, County Manager and Amy Wehrenberg, Finance Director 86 87 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: 2014 Community Health Assessment Summary of Information: Results of the latest Community Health Assessment will be shared. The full CHA document with appendices can be found by going to: http://health.personcounty.net (Health Data and Community Resources Link; Health Data link) Recommended Action: None Submitted By: LeighAnn Creson, Quality Assurance Specialist/Health Educator Person County Health Department 88 1 2014 PERSON COUNTY COMMUNITY HEALTH ASSESSMENT Person County Health Department and Healthy Personians Report to NCDPH February, 2015 89 2 TABLE OF CONTENTS Acknowledgments ...................................................................................................................... 5 Executive Summary ................................................................................................................... 6 Introduction ............................................................................................................................ 6 Person County and Its People ................................................................................................ 6 Health in Person County ......................................................................................................... 7 Community Priorities .............................................................................................................. 8 Introduction ................................................................................................................................ 9 Background ............................................................................................................................ 9 Team Selection Process ........................................................................................................10 Team Operational Process ....................................................................................................10 Key Partnerships ...................................................................................................................11 County Description ....................................................................................................................12 Data Collection Process ............................................................................................................13 Demographic, Economic and Sociodemographic Data Findings ...............................................15 Demographics .......................................................................................................................15 Age Groups ........................................................................................................................15 Economics .............................................................................................................................16 Income ...............................................................................................................................16 Employment .......................................................................................................................16 Sociodemographics ...............................................................................................................17 Housing .............................................................................................................................17 Affordable Housing .........................................................................................................18 Homelessness ................................................................................................................18 Education ...........................................................................................................................18 Higher Education ............................................................................................................18 Primary and Secondary Education .................................................................................19 Educational Attainment ...............................................................................................19 High School Drop-out Rate .........................................................................................19 Crime and Safety ...............................................................................................................20 Crime Rates ...................................................................................................................20 Juvenile Crime ................................................................................................................20 Sexual Assault and Domestic Violence ..........................................................................21 Child Maltreatment .........................................................................................................21 Adult Maltreatment .........................................................................................................21 Environmental Data Findings ....................................................................................................23 90 3 Toxic Chemical Releases ......................................................................................................23 Water Quality .........................................................................................................................24 Drinking Water Systems .....................................................................................................24 Solid Waste ...........................................................................................................................24 Solid Waste Disposal .........................................................................................................24 Health Data Findings.................................................................................................................25 Using Health Data .................................................................................................................25 Health Rankings ....................................................................................................................26 County Health Rankings ....................................................................................................26 Maternal and Infant Health ....................................................................................................27 Pregnancy Rates ...............................................................................................................27 Overall Pregnancy Rate .................................................................................................27 Teen Pregnancy Rate .....................................................................................................27 Pregnancy Risk Factors .....................................................................................................27 High Parity and Short-Interval Births ...............................................................................27 Lack of Early Prenatal Care ............................................................................................28 Smoking During Pregnancy ............................................................................................28 Birth Outcomes ..................................................................................................................28 Low and Very Low Birth Weight Births ............................................................................28 Infant Mortality ................................................................................................................28 Life Expectancy and Leading Causes of Death .....................................................................29 Life Expectancy..................................................................................................................29 Leading Causes of Death ...................................................................................................29 Morbidity and Chronic Disease ..............................................................................................34 Diabetes ............................................................................................................................34 Overweight and Obesity .....................................................................................................35 Communicable Disease .....................................................................................................36 Prevention and Health Promotion Needs and Resources ..........................................................37 Health Insurance ...................................................................................................................37 Health Care Resources .........................................................................................................39 Health Care Providers ........................................................................................................39 Health Care Facilities .........................................................................................................39 Hospital ..........................................................................................................................39 Health Department .........................................................................................................40 Federally-Qualified Health Center...................................................................................40 Emergency Medical Services .........................................................................................40 91 4 School Health .................................................................................................................40 Long-Term Care Facilities ..............................................................................................40 Home Care, Home Health and Hospice Services ...........................................................40 Mental Health Services Providers and Service Facilities ................................................41 Other Healthcare Resources ..........................................................................................41 Recreational Facilities ....................................................................................................42 Disease Prevention and Health Promotion Resources in Person County .......................42 Community Concerns Summary ...............................................................................................44 Community Priorities .................................................................................................................49 Priority Selection Process ......................................................................................................49 Priorities ................................................................................................................................50 References ...............................................................................................................................51 Appendices………………………………………………………………………………………………56 Appendix 1: Data Workbook Appendix 2: 2014 Person County Community Health Survey Appendix 3: Consultant’s Summary Report Appendix 4: 2012 Healthy Living for a Lifetime Report Appendix 5: 2013 Marshall Marketing Report 92 5 ACKNOWLEDGMENTS This document would not have been possible without the cooperation of the Person County Community Health Assessment Team. This team assisted with the development, distribution and collection of the community health survey. They also assisted with the collection of additional local data. Team members served as liaisons to other community partners. Input and expertise was also provided throughout other phases of the community health assessment process. Members of the 2014 Person County Community Health Assessment Team included:  Priscilla Bumphus (Person Family Medical and Dental Centers, Inc.)  *Beth Townsend (Piedmont Community College)  Phyllis Sutton (Community Volunteer, AARP, Person County Senior Center)  Reverend Evan Walker (Roxboro Presbyterian Church)  Anne Graham (Roxboro Housing Authority)  Jayne Bremer (Person County United Way)  *Paola Stone (Person County Health Department)  *Janet Clayton (Person County Health Department)  *Jennifer Grable (NC Cooperative Extension)  Martha Pickett (Person County Freedom House Recovery Center)  Saundra Clemmons (Community Volunteer, Person County Medical Reserve Corps)  Carlton B. Paylor, Sr. (Department of Social Services)  Ann Garrard (Person County Partnership for Children)  *LeighAnn Creson (Person County Health Department) *Also represent the Healthy Personians Partnership. We would like to thank anyone else who helped us throughout this process. Thank you to our community for completing the survey or contributing information in other ways. We are especially grateful for the assistance and expertise in data collection, analysis and reporting for the source document provided by Sheila S. Pfaender and Annika Pfaender-Purvis, Consultants. The community health assessment process, source document, and final report were made possible by financial contributions from the Person County Health Department. 93 6 EXECUTIVE SUMMARY INTRODUCTION The North Carolina Division of Public Health requires local public health agencies in North Carolina (NC) to conduct a Comprehensive Community Health Assessment (CHA) at least once every three or four years. Furthermore, a CHA is required for local public health department accreditation through the NC Local Health Department Accreditation Board (G.S. § 130A-34.1). In Person County, the partnership responsible for the CHA was led by staff of the Person County Health Department. In communities where there is an active Healthy Carolinians coalition, the CHA partnership also usually includes that entity. In Person County, the local Healthy Carolinians coalition, Healthy Personians, was an active part of the CHA team. The Health Department contracted with a private consultant for assistance in developing the 2014 CHA. The community health assessment, which is both a process and a document, investigates and describes the current health status of the community, what has changed since the last assessment, and what still needs to change to improve the health of the community. The process involves the collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, environmental data, and professional and public opinion. The document is a summary of all the available evidence and is a useful data resource until the next assessment. The completed CHA serves as the basis for prioritizing the community’s health needs and culminates in planning to meet those needs. The team’s work culminated in a comprehensive CHA report that was excerpted to create this report. The comprehensive report is available in PDF format on the Person County Health Department website (http://health.personcounty.net) via the Health Data and Community Resources link. PERSON COUNTY AND ITS PEOPLE Person County is a land-locked county located in the Piedmont Region of north-central NC and is part of the Durham-Chapel Hill Metropolitan Statistical Area. As part of the metropolitan area, it is home to workers who commute to often times lucrative jobs in Durham, Orange, and Wake counties. Before the Civil War, Person County had many large plantations. Early farmers grew tobacco, cotton, corn, wheat, oats, fruits, and vegetables, and raised cattle, hogs, and sheep. Most of the largest plantations were dismantled as part of reconstruction following the war. The present day economy of Person County is dominated by electrical, textile, administrative, manufacturing, aerodynamics, viticulture, brokering, food processing, automotive, aluminum, and paper products. Diversification from traditional flue cured tobacco to include burley tobacco and other modes of agriculture is underway. Although a variety of jobs are available in the county, 18% of the county’s workers are employed in retail trade, traditionally a low-paying sector with many part-time employees and limited benefits. A particularly noteworthy aspect of the Person County population is its age. The median age in the county is 41.4 years, four years “older” than the population for NC as a whole. The population of citizens over the age of 65 is projected to grow by 62% by 2030. It will be critical 94 7 for the community to monitor the growth of this population to address its needs, since this segment of the population tends to consume health and human services at high rates. Despite an economy that is improving nationally and locally, poverty remains significant in Person County, especially among African Americans and children. The overall 100% poverty rate in Person County in 2008-2012 was 16.2%, about the same as in NC as a whole. However, the poverty rate among African Americans in the county in the same period was 28.8%, more than twice the overall rate and 2½ times the rate among whites. Among children in the county under the age of 6, the poverty rate for the same period was 26.8%. Poverty can diminish all aspects of quality of life including health. The population in poverty is even more at risk for poor health outcomes if its members do not have health insurance. In 2010-2011, 17.1% of the Person County population between ages 0-64 lacked health insurance of any kind. Children ages 0-18 fared considerably better, with only 7.9% uninsured, due largely to growing success in enrolling eligible Person County children in NC Health Choice. HEALTH IN PERSON COUNTY Life expectancy in Person County has improved. For person born in 2010-2012, the overall life expectancy was 76.9 years, compared to 75.5 years in 1990-1992. There was significant improvement in the African American community, where despite continued poverty and poor health outcomes, life expectancy improved from 72.8 years in 1990-1992 to 75.8 years in 2010- 2012. Comparison of Person County CHA health data over the past several cycles has identified significant improvement in certain health parameters, such as the leading causes of death. Since 2001-2005, mortality rates in the county have declined overall for all leading causes of death except diabetes, Alzheimer’s disease, septicemia, chronic liver disease, and homicide. Among these causes of death, diabetes is disproportionately fatal in the Person County African American community, where the most recent mortality rate was three times the mortality rate for whites. According to the CDC, the prevalence of diagnosed adult diabetes in Person County in 2011 was approximately 11%. On the 2014 Community Health Survey, 28% of African American respondents reported having been diagnosed with diabetes, compared to 11% of white respondents. The respondents on the 2014 Person County Community Health Survey identified diabetes as the fifth most important health problem in the community. Among the lifestyle factors contributing to diabetes prevalence and mortality, overweight and obesity are perhaps the most important. According to the CDC the prevalence of diagnosed adult obesity in Person County in 2011 was 33%, and prevalence had averaged 32% from 2006 through 2011. This prevalence of adult overweight/obesity was corroborated by local data. A 2012 community health screening revealed 48% of study participants had BMIs in the “high risk” category of >29.9 kg/m2, and according to results of a Marketing Report prepared for Person County in 2013, 35% of adult survey respondents reported that a doctor had told them that they were either overweight (32%) or obese (3%). Finally, in results from the 2014 Person County Community Health Survey, 43% of respondents self-reported having received a medical diagnosis of overweight/obesity. On that same survey, respondents identified obesity/overweight as the second most important community health problem after cancer. They also recognized lack of exercise and poor eating habits as third and fourth most important unhealthy behaviors in the Person County community. 95 8 Between 2001-2005 and 2008-2012, cancer mortality rates in Person County decreased for prostate, colorectal, and pancreas cancers, but increased for breast cancer and lung cancer. The increased lung cancer mortality rate and a 13% increase in the county chronic lower respiratory disease mortality rate since the last CHA are worrisome. Smoking remains prevalent in Person County even among pregnant women, and community health surveys have identified a fraction of the population that does not want to stop smoking. It is possible that smoking-associated morbidity and mortality could increase in coming years. In some but not all aspects, maternal and infant health in Person County have improved since around the time of the last CHA. For example, the pregnancy rate for teens (girls ages 15 through 19) fell by over 31% between 2008 and 2012. However, although the teen pregnancy rate fell over that period for both white and African American girls, the 2012 rate for African American teens was 2½ times the rate for white teens. The frequency of high parity and short-interval births in the county exceeded the state averages in 2008-2012, and utilization of early prenatal care fell from 90% in 2008 to 60% in 2012. The overall infant mortality rate in Person County fell from 9.3 deaths per 1,000 live births in 2005-2009 to 6.5 deaths in 2008-2012; however, in 2008-2012 the infant mortality rate among African Americans in the county was twice the rate among whites. COMMUNITY PRIORITIES After receiving primary and secondary data reports from the consultant, the CHA team was involved in a series of meetings to work towards establishing priorities. The importance of broad community involvement from the public, stakeholders, partners, and diverse populations was emphasized. It was concluded that the most feasible way to achieve this was to use a priority setting survey. A broadly distributed Survey Monkey tool was used to collect community input on priorities and to analyze the responses. The team made concerted efforts to get survey involvement from both genders, different age groups, and minorities. The Health Department’s Foreign Language Interpreter conducted the survey via interview style with non-English speaking clients. The survey generated more responses from both elected and appointed county officials than it had in the past. There were 335 surveys completed which was more than twice as many as were completed in 2011. During the two and half weeks that the survey was being conducted, the CHA team met several times to review existing data. An adaptation of the “Hanlon Method” was used to correlate the data. An initial list of health problems was rated by the team with respect the magnitude of the problem, the seriousness of consequences of the problem, and the feasibility of correcting the problem. Other factors taken into consideration by the team included, for example, how the issues aligned with Healthy NC 2020 objectives, themes that recurred over time, and the county’s capacity to address issues. Once the priority setting survey closed, the team reviewed the results and factored them into the ratings. The vast majority of this new survey data aligned with the ratings, and the same issues continued to surface thus affirming the direction that the team was heading in terms of establishing priorities. After four meetings and conducting this additional survey the following were established as Person County’s health priorities for the next four years (2015-2019):  Chronic Disease: Diabetes  Overweight/Obesity 96 9 INTRODUCTION BACKGROUND Local public health agencies in North Carolina (NC) are required to conduct a Comprehensive Community Health Assessment (CHA) at least once every three or four years. The CHA is required of public health departments in the consolidated agreement between the NC Division of Public Health (NCDPH) and the local public health agency. Furthermore, a CHA is required for local public health department accreditation through the NC Local Health Department Accreditation Board (G.S. § 130A-34.1). In communities where there is an active Healthy Carolinians coalition, the CHA partnership also usually includes that entity. Healthy Carolinians is “a network of public-private partnerships across North Carolina that shares the common goal of helping all North Carolinians to be healthy.” The members of local coalitions are representatives of the agencies and organizations that serve the health and human service needs of the local population, as well as representatives from businesses, communities of faith, schools and civic groups. In Person County, the local Healthy Carolinians coalition is Healthy Personians (HP). The community health assessment, which is both a process and a document, investigates and describes the current health status of the community, what has changed since the last assessment, and what still needs to change to improve the health of the community. The process involves the collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, environmental data, and professional and public opinion. The document is a summary of all the available evidence and is a useful data resource until the next assessment. The completed CHA serves as the basis for prioritizing the community’s health needs and culminates in planning to meet those needs. The Person County Health Department (PCHD) contracted with Sheila S. Pfaender, Public Health Consultant, to assist in conducting the 2014 Community Health Assessment for Person County, following the guidance provided by the Community Assessment Guidebook: North Carolina Community Health Assessment Process, published by the NC Office of Healthy Carolinians/Health Education and the NC State Center for Health Statistics (December 2011, updated December 2012) and by process modifications enacted by NCDPH in January 2014. The assessment also adheres to the 2014 standards for community assessment stipulated by the NC Local Health Department Accreditation (NCLHDA) Program. The CHA coordinator from PCHD worked with the consultant to develop a multi-phase plan for conducting the assessment. The phases included: (1) a secondary data research phase to identify, collect and analyze secondary demographic, socioeconomic, health, and environmental data; (2) a primary data research phase to collect and analyze data collected via a community survey; (3) a data synthesis and analysis phase; (4) a period of data reporting and discussion among the project partners; and (5) a prioritization and decision-making phase. Upon completion of this work, the CHA partners and the community will have the tools they need to develop plans and activities that will improve the health and well-being of the people living in Person County. The consultant provided direct technical assistance for phases 1, 2, 3 and 4. The team’s work culminated in a comprehensive CHA report that was excerpted to create this report. 97 10 TEAM SELECTION PROCESS In larger counties where community partners are more plentiful and not as frequently exhausted by service on multiple committees it may be more feasible to establish both an advisory group and work group for the Community Health Assessment (CHA) process. However, this is not reality for most small, rural counties such as Person County. Therefore, one CHA team was formed that served simultaneously in advisory and working capacities. Efforts of the CHA team were coordinated by a Project Facilitator. Person County Health Department’s Health Educator served as the Project Facilitator. In January 2014, the Health Director and Project Facilitator generated a list of partners to approach about service on a CHA team. This task was more challenging than in previous years since there were transitions within some local agencies and organizations—including the hospital—and the availability of personnel to serve in additional capacities was more limited. Factors taken into consideration when generating the list of potential partners included: (1) diversity and having a representation of county demographics, (2) previous involvement in the CHA process, (3) a vested interest in public health, (4) expertise in various fields that can impact health, (5) representation from community members, (6) involvement in the Healthy Personians Partnership, (7) partner reputation and reliability, and (8) partner connections within the community. The Health Director and Project Facilitator from the Health Department made contact with potential partners, provided information about the CHA process, secured commitments, and extended an invitation to participate in the initial team meeting in March 2014. While there were a few veteran CHA Team members, the majority of the team was new to the process. At the beginning of the process, the team was fortunate enough to have representation from the local hospital. Due to unforeseen circumstances this partner was unable to fulfill their commitment and a replacement was not available. However, the hospital continued to be a partner in the process through the provision of local data. Person County Schools was an honorary partner as they were unable to serve on the team yet were very helpful in providing data for the CHA and assisting with survey distribution efforts. TEAM OPERATIONAL PROCESS The initial CHA team meeting/orientation was held in March 2014. CHA team members were provided a brief history of the CHA in Person County, oriented about the eight phases of the process along with a timeline for each phase, informed about the changes in requirements since the 2011 CHA, and made aware of the expectations of team members. At the conclusion of the meeting, team members began work on developing the community health survey and identifying what local data would need to be collected by the team. Monthly team meetings were held March-May along with communication in the interim via email and phone. The team was tasked with promoting and distributing the community health survey from April-June. Additionally, during this time frame team members worked with other community partners to obtain local data. By the end of June, 624 surveys had been completed and the team had submitted all of the local data collected to the Public Health Consultant working with the Health Department. In September 2014, a data report and analysis was presented to the team by the consultant. The team met several times throughout October and November to study the data further and work through a process to determine health priorities for the county until the next assessment. That priority selection process is detailed later in this report. The team will continue to be involved in this process through the dissemination of the final report and establishment of a community action plan in early 2015. 98 11 KEY PARTNERSHIPS Collaboration between Person County Health Department, the Public Health Consultant, and local partners made this assessment possible. Many partners spent numerous hours attending team meetings, collecting local data, promoting and distributing both the initial community health survey and then later the priority setting survey, and assisting the Project Facilitator in various ways. Additional partners, who were unable to serve on the team, contributed to the process through providing data and assisting with survey distributions. A collective list of the key partners in the 2014 CHA process in Person County includes:  Person County Medical & Dental Centers, Inc.  Person Memorial Hospital  Person County Department of Social Services  Person County Schools  Person County Partnership for Children  Roxboro Community School  Piedmont Community College  Person County Emergency Management  Person County United Way  Person Area Transportation System  North Carolina Cooperative Extension Service  Roxboro Presbyterian Church  Person County Freedom House Recovery  Person County Inspections  Roxboro Housing Authority  Person County Library  Healthy Personians Partnership  La Veracruzana Tienda  Person County Medical Reserve Corps  Safe Haven of Person County  Community members 99 12 COUNTY DESCRIPTION Person County is a land-locked county located in the Piedmont Region of north-central NC. It is bordered to the west by Caswell County, NC, to the east by Granville County, NC, to the south- southeast by Durham County, NC, and to the south-southwest by Orange County, NC. Virginia (specifically Halifax County, VA) lies along the county’s northern border. Person County encompasses a land area of approximately 392 square miles and a water area of 12 square miles. Most of the county is rolling hills divided by farmland and forest. The county is divided geopolitically into nine township districts: Allensville, Bushy Fork, Cunningham, Flat River, Holloway, Mount Tirzah, Olive Grove, Roxboro, and Woodsdale Townships. The City of Roxboro is the county seat and is the only incorporated municipality in the county. Hyco Lake and Mayo Reservoir, both located in the northern part of the county, are used to support commercial electricity generation as well as for recreation. Lake Roxboro, located near the county’s western border with Caswell County, serves as a source of community drinking water. Person County’s primary ground transportation routes are two US Highways (501 and 158) and three NC Highways (157, 57, and 49). No Interstate highways traverse the county, but I-85 is located approximately 30 miles to the east. Rail service consists primarily of switching services for the Norfolk Southern Railroad along its Roxboro-South Boston (VA) route. No passenger air services are available in the county; two regional airports (Raleigh/Durham International Airport, 45 miles to the southeast) and Piedmont/Triad International Airport in Greensboro, 60 miles to the southwest) meet most residents’ air travel needs. Business and general aviation needs are met locally at the Person County Executive Airport, which has a 6,500-foot paved and lighted runway. The county has no regularly-scheduled long-distance passenger bus service. The nearest commercial bus stations are Greyhound Terminals in Durham, NC and Danville, VA. The area of today’s Person County is said to have been inhabited by indigenous peoples for 12,000 years. European explorers began arriving in the area in the seventeenth century, but true settlement did not occur until the mid-seventeenth through nineteenth centuries. The earliest immigrant settlers were Scots, Scots-Irish, English, French Huguenots and Germans. Before the Civil War, Person County had many large plantations. Early farmers grew tobacco, cotton, corn, wheat, oats, fruits, and vegetables, and raised cattle, hogs, and sheep. Most of the largest plantations were dismantled as part of reconstruction following the war. In the late 19th Century, several community leaders helped the county diversify its economic base to include banking, cotton milling, and textiles in addition to agriculture. Also, noteworthy about this time was the arrival of the Norfolk and Western Railroad, which stimulated the addition of tobacco processing plants and warehouses to the rural economy. The tobacco processing plants disappeared many years ago, although a few warehouses still stand, and most of the textile manufacturers have moved to other locations in the US and overseas. Residential growth in the county today is located primarily in the Lakes region in the north, and in the southern portion of the county (where growth is at least partly due to proximity to the employment mecca of the Research Triangle Park in Durham and Wake Counties). The present day economy of Person County is dominated by electrical, textile, administrative, manufacturing, aerodynamics, viticulture, brokering, food processing, automotive, aluminum and paper products. Diversification from traditional flue cured tobacco to include burley tobacco and other modes of agriculture is underway (1). 100 13 DATA COLLECTION PROCESS Most data referred to in the present document were derived, unless otherwise specifically noted, from the consultant’s comprehensive report, 2014 Person County Community Health Assessment: Secondary Data and Community Health Survey Report, which is available on the Person County Health Department website. (Every data source included in that “parent” document is thoroughly cited as to the original source.) The consultant’s data collection process is described below. In order to learn about the specific factors affecting the health and quality of life of Person County residents, the consultant tapped numerous readily available secondary data sources. For data on Person County demographic, economic and social characteristics sources included: the US Census Bureau; Log Into North Carolina (LINC); NC Office of State Budget and Management; NC Department of Commerce; Employment Security Commission of NC; NC Division of Aging and Adult Services; NC Child Advocacy Institute; NC Department of Public Instruction; NC Department of Justice; NC Department of Juvenile Justice and Delinquency Prevention; NC Department of Administration; NC Division of Medical Assistance; NC Division of Child Development; NC State Board of Elections; NC Division of Health Services Regulation; the Cecil B. Sheps Center for Health Services Research; and the Annie E. Casey Foundation Kids Count Data Center. Local sources for socioeconomic data included: the Person County Department of Social Services; the Person County Chamber of Commerce; Person County Public Schools; and other Person County agencies and organizations. The author has made every effort to obtain the most current data available at the time her report was prepared (October 2013 through June 2014). The primary source of health data for the consultant’s comprehensive 2014 Person County Community Health Assessment Report was the NC State Center for Health Statistics, including its County Health Data Books, Behavioral Risk Factor Surveillance System, Vital Statistics, and Cancer Registry. Other health data sources included: US Centers for Disease Control and Prevention; NCDPH Epidemiology Section; NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services; National Center for Health Statistics; Healthy People 2020; NCDPH Nutrition Services Branch; UNC Highway Safety Research Center; NC Department of Transportation; and the NCDPH Oral Health Section, among other public domain sources. Other important local health data sources included PCHD, Person County Schools, Person Memorial Hospital, Person County Department of Social Services, Person County Freedom House Recovery Center, and Person County Emergency Medical Services. Because in any community health assessment it is instructive to relate local data to similar data in other jurisdictions, Person County data is compared to like data describing the state of NC as a whole, as well as data from Bladen County, NC, which was approved as Person County’s “peer county” by the NC DPH Local Technical Assistance and Training Branch by special request of the Person County Health Department. In some cases Person County data is compared to US-level data or other standardized measures. Where appropriate, trend data was used to show changes in indicators over time, at least since the previous Person County CHA three years ago, but sometimes further back than that. Environmental data were gathered from public domain sources including: US Environmental Protection Agency, NC Department of Environment and Natural Resources Divisions of Air Quality and Waste Management, the Section of Environmental Health in NCDPH, and the NC State Laboratory of Public Health. 101 14 Finally, it should be noted that as is typical in all time-limited activities such as community health assessment, all data were mined at points in time in the recent past and may not represent present conditions. Numbers, entity names, program titles, etc. that appear in the consultant’s report may no longer be current. The consultant’s comprehensive report represents a topical synthesis of all the secondary data researched in connection with the 2014 Person County CHA project, as well as data collected via the 2014 Person County Community Health Survey. Her report was intended from the outset to serve as the master data resource for guiding community deliberations about the most important health issues in Person County and how to solve them. That comprehensive report is available on the Person County Health Department website (http://health.personcounty.net ) via the Health Data and Community Resources link. Selected data from the comprehensive report used to support the discussion in this document is attached, as Appendix 1: Data Workbook. A complete discussion of the 2014 Person County Community Health Survey (process, results, analysis and instruments) is attached as Appendix 2: 2014 Person County Community Health Survey. The consultant’s PowerPoint presentation summarizing the secondary data and community survey is attached as Appendix 3: Consultant’s Presentation. The final attachments contain locally-generated supporting data: Appendix 4: 2012 Healthy Living for a Lifetime Report, and Appendix 5: 2013 Marshall Marketing Report. 102 15 DEMOGRAPHIC, ECONOMIC AND SOCIODEMOGRAPHIC DATA FINDINGS DEMOGRAPHICS According to the 2010 US Census, the population of Person County is 39,464, slightly more than half of whom (52%) are females. Racial and ethnic diversity in Person County is similar to that of North Carolina as a whole: 68% white, 27% African American, and 4% Hispanic/Latino (the comparable percentages for NC are 69% white, 22% African American, and 8% Hispanic/Latino (2). Age Groups Perhaps the most noteworthy aspect of the Person County population is its age. The median age in the county is 41.4 years, four years “older” than the population for NC as a whole. Furthermore, the graph of population distributions for Person County and NC shown below demonstrates how the Person County population has higher percentages of “older” residents, and lower percentages of “younger” residents, especially the 20-35 year-old age group, than NC (3). Population Distribution, by Age Group Source: US Census Bureau, American FactFinder, 2010 Census, 2010 Demographic Profile Data, Summary File DP-1, Profile of General Population and Housing Characteristics: 2010 (Geographies as noted); http://factfinder2.census.gov. The “gap” in the number of persons of younger working age might indicate that employment opportunities in Person County are not sufficient to attract and keep young workers, since much of the “missing” age group is beyond college age. Its larger-than-NC average proportions of older residents should be of concern to the county, since this is a population group that tends to utilize health and human services at higher rates than younger age groups. Exacerbating current concern about older segments of the population is projected growth in the population over the age of 65. According to US Census Bureau figures, the overall population of Person County is expected to grow by approximately 10% between 2010 and 2030 (4). 103 16 Apparently much of this growth will occur among older population groups. According to figures from the NC Office of State Budget and Management, the population of persons age 65 and older in Person County is projected to grow from 5,993 at the time of the 2010 US Census to 9,719 by 2030, an increase of 62%. More specifically, between 2010 and 2030 the Person County population age 65-74 is projected to grow by 55%, the population age 75-84 by 79%, and the population over age 85 by 37% (5). One concern in meeting the future, and perhaps even the current needs, of its elderly population is the relative dearth of beds in long-term care facilities in Person County. As of the July 2014 listing of NC-licensed long-term beds by the NC Division of Health Services Regulation, there were 214 beds in Adult Care Homes/Homes for the Aged, 12 beds in Family Care Homes, and 140 beds in Nursing Homes and Homes for the Aged that can provide skilled nursing, for a subtotal of 366 beds (6). In addition, Person Memorial Hospital can provide 60 additional long-term beds in its skilled nursing facility, bringing the current total of long-term beds in the county to 426 (7). If the current number of long-term beds does not change, the ratio of beds to population over the age of 65 will decrease from 1:14 to 1:23. An alternative to institutional care preferred by many disabled and senior citizens is to remain at home and use community in-home health and/or home aide services. As of July 2014, there were four NC-licensed home care, home health and hospice services in Person County (8). In addition, the Person County Department of Social Services provides a number of home-care related services for their indigent clients who qualify for other government services. Data from Person County DSS show that utilization of these services has remained flat or decreased during the past three fiscal years (9), but that may be more representative of agency funding realities than of actual need or demand. The fact of the growing elderly population in Person County points to closer investigation of the adequacy of current resources for this population group, and of new facilities and services that might be necessary to meet future needs. ECONOMICS The NC Department of Commerce annually ranks the state’s 100 counties based on economic well-being and assigns a Tier Designation, where the 40 most distressed counties are Tier 1, the next 40 are Tier 2, and the 20 least distressed are Tier 3. In 2014, Person County was assigned Tier 2 Designation (10). With this Tier Designation, Person County is not eligible to offer the same economic incentives to prospective businesses as its Tier 1 neighbors. Income Regardless of income category designation, per capita incomes in Person County fell below comparable state figures in 2011/2012. Projected 2012 per capita personal income in Person County was $3,462 lower than the comparable state average, and the projected 2012 median household income in the county was $4,088 lower than the comparable state average. Estimated 2011 median family income in Person County was $430 lower than the comparable state average (11). These differences are due partly to the proportion of low-wage earning persons in Person County. Employment In 2012, the employment sector in Person County that employed the largest percentage of the workforce (18%) was Retail Trade, with an average annual wage of $20,166. This percentage 104 17 includes many part-time workers, and many whose employers do not provide health benefits. For comparison, this sector statewide employs approximately 12% of all workers, at an average annual wage of $25,209. In 2012, for all employment sectors the average annual wage per worker in Person County was $33,528, $14,580 (or 30%) less than the average annual wage per worker statewide (12). As elsewhere in NC, the unemployment rate in Person County (calculated by dividing the number of unemployed persons in the county by the number of people in the county’s civilian labor force) accelerated abruptly between 2008 and 2009, with the onset of the nation-wide economic recession. Beginning between 2010 and 2011 unemployment in both NC and Person County began to decrease at similar rates, and at the end of 2012 their unemployment rates were almost the same, at 9.5% and 9.7% respectively. In Bladen County, Person County’s peer for the purposes of this CHA, the unemployment rate was higher throughout the recession and continued to increase past 2009 (13). Interestingly, the annual poverty rate (100% level) in Person County did not appear to follow the trend that would be expected on the basis of the county’s unemployment figures. In Person County, the overall annual poverty rate (100% level) peaked at 18.1% in the aggregate period 2007-2011 and fell to 16.4% in the subsequent 2008-2012 period, the “heart” of the recession. Meanwhile, statewide the comparable rates were 16.1% in 2007-2011 and 16.8% in 2008-2012. In Bladen County, where unemployment was higher, the poverty rate was 23.6% in 2007-2011 and 24.4 in 2008-2012 (14). Despite overall poverty rates that fell as the recession continued, African Americans in all three jurisdictions endured poverty at much higher rates than their white counterparts. Throughout the periods 2006-2010, 2007-2011 and 2008-2012, the poverty rate among blacks in Person County was more than twice than the comparable rate for whites (15). Another group that suffers disproportionately from poverty is children. Youth under the age of 18, and especially those under the age of 5, have higher poverty rates than the overall population in all three comparator jurisdictions. In the 2008-2012 period in Person County, the proportion of related children under age 18 living at or below the 100% poverty level stood at 19.9%, and the proportion of children under age 5 living under the same circumstances was 26.8%. In the same period the comparable overall poverty rate in the total population was 16.4% (16). Poverty can diminish all aspects of quality of life including health. The population in poverty is even more at risk for poor health outcomes if its members do not have health insurance. The uninsured population in Person County will be discussed more fully in the Health Resources section of this report. SOCIODEMOGRAPHICS Housing Housing is often the largest expense for a household. A benchmark sometimes used to compare housing expense among communities is to cite the proportion of household units spending 30% or more of total household income on housing. In 2008-2012, 47% of rental units and 30% of mortgaged units in Person County were paying 30% or more on housing, compared to figures of 51% and 33%, respectively, statewide. The percentage of renter occupied housing 105 18 units in Person County spending more than 30% of household income on housing decreased by 11% between 2005-2009 and 2008-2012, while the percent of mortgaged housing units costing more than 30% of household income decreased by 14% over the same period (17). According to other US Census housing data, there was a slightly higher estimated proportion (15.2%) of vacant housing units in Person County than in NC as a whole (14.6%) during the period cited. Of the estimated total occupied housing units in Person County, 73% were owner-occupied, and 27% were renter-occupied. In Person County, approximately 24% of all housing units were classified as mobile homes, a figure 72% higher than the NC average. In the period cited, the estimated median monthly mortgage cost in Person County was $160 lower than the state average, and the estimated gross monthly rent in Person County was $110 lower than the state average (18). Affordable Housing According to information from the NC Rural Economic Development Center based on 2006- 2010 US Census data estimates, 27% of housing in Person County was classified as “unaffordable”, compared to 31% in Bladen County and 32% statewide (19). This data is at least partially reflective of the population living in households that pay more than 30% of the household income for housing costs. Homelessness According to data from the NC Housing Coalition, there is at the present time one homeless shelter in Person County: Safe Haven of Person (20). Technically, however, this facility provides temporary homes only to victims of domestic abuse. The NC Coalition to End Homelessness assists local jurisdictions in conducting an annual “point-in-time” survey of homeless persons every autumn. The 2014 PiT survey in Person County counted 15 homeless persons (11 adults over the age of 25 and four children) (21). Education Higher Education There is one college-level educational institution in Person County: Piedmont Community College. Piedmont Community College (PCC) is a public two-year college and a member of the 58-institution NC Community College System. It provides educational opportunities to approximately 55,000 residents in rural Person and Caswell counties. The college has two campuses: the main campus is located in Roxboro (Person County); the other is in Yanceyville (Caswell County). The college’s curriculum leads to Associate degrees, diplomas, or certificates in over 35 programs of study. Beyond its academic programs PCC is the primary provider of adult education, training and retraining for the local workforce. The college offers a large variety of Continuing Education classes and services to business, industry and the community, including specialized training for Fire, Rescue/EMS and Law Enforcement workers; adult literacy services; and English as a Second Language classes. The college offers a broad range of Distance Learning classes and is a leader among community colleges in NC in the number of students enrolled in programs offered on the Internet, the NC Information Highway, videos, television, DVDs, or a combination of one of these methods and traditional face-to-face classes (22). 106 19 Primary and Secondary Education There are 12 public schools in the Person County school district, including two charter schools (23). There are also three private schools in the county (24). According to NC Department of Public Instruction figures, enrollment in Person County non- charter public schools decreased annually between SY2006-2007 and SY2012-2013. Regarding the county’s charter schools, enrollment at Roxboro Community School increased and enrollment at Bethel Hill Charter School remained steady (25). Educational Attainment As of a 2008-2012 US Census Bureau estimate, Person County had lower percentages of both high school graduates and residents with a bachelor’s degree or higher than NC as a whole. According to SY2012-13 End of Grade (EOG) Test results, third graders and eighth graders in Person County public schools demonstrated grade-appropriate proficiency in reading and math at lower percentages than students statewide. Students enrolled in the county’s two charter schools performed at proficiency rates higher than the state average. It should be noted that SY2012-13 was the first year of implementation of the new statewide Standard Course of Study, new assessments, and a new school accountability model. As a result, student performance data from SY2012-13 is very different from, and is not directly comparable to, similar data from previous years. In SY2011-12, the average total SAT score for students in the Person County public schools (963) was below the average total SAT score for students statewide (1001). Average SAT scores for students at Roxboro Community School (1039) were higher than the state average. High School Drop-out Rate According to the NC Department of Public Instruction, a "drop-out" is any student who leaves school for any reason before graduation or completion of a program of studies without transferring to another elementary or secondary school. Specific to high school students in regular (non-charter) public schools in Person County, the drop-out rate fluctuated from SY2005-2006 through SY2012-2013, but fell from 6.10 in SY2011-2011 to 4.19 in SY2012- 2013. However, the Person County drop-out rate in SY2012-2013 exceeded the comparable state rate by 71%. More time-limited data for Roxboro Community school (SY2008-2009 through SY2012-2013) demonstrated a drop-out rate consistently less than one (26). Some educators prefer to use graduation rate rather than drop-rate when discussing the proportion of students who finish/do not finish school, since it emphasizes success rather than failure. The four-year cohort graduation rates for subpopulations of 9th graders in Person County entering public high school in SY2009-10 and graduating in SY2012-13 are as follows: The overall graduation rate (77.5%), the graduation rate among males (76.3%), the graduation rate among females (78.8%), and the graduation rate among economically disadvantaged students (71.9%) in the Person County LEA (Local Education Authority) all were lower than the comparable state rates of 82.5%, 78.6%, 86.6% and 76.1%, respectively (27). According to information provided by Roxboro Community School, the Person County charter school with high school students, the comparable four-year cohort graduation rate there was 93.7% (28). 107 20 Crime and Safety Crime Rates The NC Department of Justice catalogs data on index crime. Index crime is composed of violent crime and property crime. Violent crime includes murder, forcible rape, robbery, and aggravated assault; property crime includes burglary, larceny, arson, and motor vehicle theft. The overall index crime rate in Person County fell 25% overall between 2008 and 2012, and was lower than the comparable state rate in each of the years cited. The largest component of Person County index crime was property crime, rates for which also were consistently lower than the comparable rates for the state as a whole (29). Violent crime can be subdivided further into the following categories: murder, rape, robbery (larceny by the threat of violence); and aggravated assault (a physical attack on another person which results in serious bodily harm and/or is made with a deadly or dangerous weapon such as a gun, knife, sword, ax or blunt instrument). Property crime can be subdivided into: burglary (unlawful breaking and entering into the premises of another with the intent to commit a felony); larceny (the theft of property without use of force); and motor vehicle theft (the theft or attempted theft of a motor vehicle). In Person County, the predominant violent crime reported in every year cited was aggravated assault, and the predominant property crime reported in every year cited was larceny (30). Besides index crime, a series of other criminal activities occurs in Person County. For example, as of February 13, 2014 there were 73 registered sex offenders in Person County (31). According to the NC Governor’s Crime Commission, there were two gangs reported in Person County in 2013 (32). And finally, according to the NC State Bureau of Investigation, there were no methamphetamine drug lab busts in Person County during the period from 2005 through 2013 (33). Juvenile Crime The following definitions will be useful in understanding the subsequent data and discussion. Complaint: A formal allegation that a juvenile committed an offense, which will be reviewed by a counselor who decides whether to approve or not approve the complaint. If approved, it will be heard in juvenile court. Undisciplined: Describes a juvenile between the ages of six and 16, who is unlawfully absent from school, or regularly disobedient and beyond disciplinary control of parent/guardian, or is regularly found where it is unlawful for juveniles to be, or has run away from home for more than 24 hours. It also includes 16-17 year olds who have done any of the above except being absent from school. Delinquent: Describes a juvenile between the ages of six and not yet 16 who commits an offense that would be a crime under state or local law if committed by an adult. The number of complaints for undisciplined youth in Person County fell from 65 in 2010 to 39 in 2012, a 40% decrease. Over the same period the number of complaints of delinquent youth in Person County rose from 148 to 190, a 28% increase (34). It is unclear whether this pattern reflects a real worsening of behavior among youth or a change in the reaction of complainants regarding what behaviors they think they are seeing. 108 21 Sexual Assault and Domestic Violence According to data from the Domestic Violence Commission of the NC Council for Women on the number of individuals who filed complaints of sexual assault in the period from FY2004-2005 through FY2011-2012, the annual number of sexual assault complaints statewide increased 58% between 2008-2009 and 2009-2010, which corresponds to the beginning and early years of the recent economic recession. The annual number of complaints statewide remained at 2009-2010 levels through 2011-2012 (35). This increase is not surprising, since it is not unusual for complaints of sexual assault to increase when social stresses increase. Unfortunately, comparable data for Person County is not available at the source. The same state source catalogues data on complaints of domestic violence. Between FY2004- 2005 and FY2011-2012 the annual number of complaints varied in Person County, Bladen County and the state as a whole without a clear pattern. However, the number of complaints in Person County appeared to have doubled between FY2009-2010 and FY2010-2011, increasing from 91 to 181 and remaining high (178) the following year (36). This “burst” of complaints is a year later than the comparable increase in sexual assault complaints, but may also relate to economic conditions spreading throughout the community. Child Maltreatment The responsibility for identifying and reporting cases of child abuse, neglect, and exploitation falls to the child protective services program within a county’s department of social services. Generally speaking, such a unit will have sufficient staff to handle intake of all reports. However, an agency’s ability to investigate and monitor reported cases may vary from year to year, depending on the number of properly trained staff available to it; hence, follow-up on reports may vary independently of the number of reports. Between 2004-2005 and 2012-2013, the total number of findings of child abuse, neglect or dependency in Person County fluctuated without a clear pattern except that recent figures appeared lower than pre-2011-2012 figures. Over the period cited, the highest numbers of findings were 352 in FY2005-2006 and 303 in FY2006-2007, and the lowest was 151 in 2011-2012. The average number of findings of child abuse, neglect, or dependency per year throughout the period cited was 248. The total number of substantiated findings of abuse and neglect, abuse only, and neglect only covered annually by those reports ranged from a low of 16 in FY2008-2009 to a high of 46 in FY2004-2005, and averaged 35 per year (37). (A "substantiated" report of child abuse, neglect or exploitation indicates that the investigation supports a conclusion that the subject child(ren) was/were abused, neglected, or exploited.) The findings and substantiated cases of child abuse in Person County appear to have little connection to the timing of the economic recession. Adult Maltreatment Adults who are elderly, frail, or mentally challenged are also subject to abuse, neglect, and exploitation. County DSS Adult Protective Services units screen, investigate, and evaluate reports of what may broadly be referred to as adult maltreatment. According to data from the NC Division of Aging and Adult Services, it would appear that 38% more cases of adult maltreatment were “screened in” (i.e., deemed appropriate for further service) in Person County in 2011 than in 2009 (38). 109 22 Data for a subsequent period (FY2010-2011 through FY2012-2013) provided by the Person County Department of Social Services showed that the number of reports of adult maltreatment meeting the standards for investigation, as well as the number of cases meriting services, were similar from year to year over the period cited. The number of cases meeting standards for investigation ranged from 70 to 74 annually over the period, and the number of cases meriting services ranged from 32 to 37 annually (39). 110 23 ENVIRONMENTAL DATA FINDINGS TOXIC CHEMICAL RELEASES Person County is among the NC counties with the largest volumes of toxic releases. The US Toxic Releases Inventory (TRI) program is the tool the Environmental Protection Agency (EPA) uses to track industrial releases of toxic chemicals to land, air and water. Approximately 20,000 industrial facilities are required to report estimates of their environmental releases and waste generation annually to the TRI program office. Note that these reports do not cover all toxic chemicals, and they omit pollution from motor vehicles and small businesses (40). In 2012, almost 3.7 million pounds of TRI chemicals were released in Person County, the fourth highest total volume of releases in the state (41). TRI releases in Person County in 2012 represented 7% of all TRIs released in NC in 2012. Two power generating facilities—the Mayo Electric Generating Plant and the Roxboro Steam Plant, both operated by Duke Energy—were responsible for the largest volumes of nine of the ten TRI chemicals/chemical compounds released in the highest amounts in Person County in 2012 (42). Although TRI releases in Person County remain among the highest in the state, the releasing industries have reduced the amount of TRI chemicals they released over time, especially since 2000. The graph below plots the weight, in pounds, of total TRI chemicals released annually by all industries in Person County beginning in 1988. Total TRI Release Trend, 1988 Core Chemicals List, Person County (1988-2012) Source: US EPA TRI Explorer, Releases: Trends Report, North Carolina, Person County. http://iaspub.epa.gov/triexplorer/tri_release.trends. 111 24 WATER QUALITY Drinking Water Systems The EPA’s Safe Drinking Water Information System (SDWIS) contains information about public water systems and their violations of EPA's drinking water regulations, as reported to EPA by the states. These regulations establish maximum contaminant levels, treatment techniques, and monitoring and reporting requirements to ensure that water systems provide safe water to their customers (43). In February 2014, SDWIS listed 54 active water systems in Person County. Four were community water systems that served 12,587 people. A community water system is one with at least 15 service connections used by year-round residents or regularly serves 25 year-round residents. This category includes municipalities, subdivisions, and mobile home parks. In addition to the four community water systems in Person County, there were also four non-transient, non-community water systems (N-T/N-C) serving 1,289 people and 46 transient, non- community (T/N-C) water systems serving 3,550 people. Water systems in the N-T/N-C category regularly supply water to at least 25 of the same people at least six months per year, but not year-round. Some examples are schools, factories, office buildings, and hospitals which have their own water systems. Water systems in the T/N-C category do not consistently serve the same people, and include rest stops, campgrounds, and gas stations. According to the data from SDWIS, active community water systems in Person County serve approximately 32% of the population. The remaining 68%, a significant segment of the county population, get their water from private wells or other sources and are at greatest risk for environmental contamination of their water source (44). SOLID WASTE Solid Waste Disposal The solid waste disposal trend in Person County is moving in the wrong direction. In FY2012-13, Person County managed 39,560 tons of municipal solid waste (MSW) for a rate of 1.0 tons per capita, an increase of 26% from the per capita rate for FY1991-92 (the period customarily used for the base rate). During the same 2012-13 period, the overall state per capita solid waste management rate was 0.94, 12% less than the FY1991-92 base per capita rate (45). Some of the solid waste generated within Person County is transferred or transported directly to landfills outside the county, but the vast majority (99%) is landfilled within its boundaries, at the Upper Piedmont Regional Environmental Landfill located in in Rougemont (46). This landfill currently has capacity projected to last for another 35 years (47). The local governments in Person County are aware of the solid waste problem. According to the 10 Year Solid Waste Management Plan for Person County and the City of Roxboro released in December, 2012, the municipalities were aware that they could not attain the 2006 goal of reducing waste to 0.76 tons per capita by 2012. In response, the city and county planned to introduce a number of new programs aimed at increasing diversion of solid waste from landfills to recycling and other reduction strategies (48). Time will tell if these strategies will work to reduce solid waste in the county. 112 25 HEALTH DATA FINDINGS USING HEALTH DATA Routinely collected surveillance data can be used to describe—and compare—the health status of communities. These data, which are readily available in the public domain, typically use standardized definitions. Some of the important terms used in this section of the report are defined or explained below, excerpted from the consultant’s comprehensive CHA report:  Mortality rate – The mortality rate, or the rate of death, is calculated by dividing the number of deaths in a target population in a given time period due to a specific cause by the total number of persons in the target population in the same period. Mortality rate typically is described as number of deaths per 100,000 persons.  Age-adjustment - Many factors can affect the risk of death, including race, gender, occupation, education and income. The most significant factor is age, because as a population ages, its collective risk of death increases. At any one time some communities have higher proportions of “younger” people, and others have a higher proportion of “older” people. In order to compare mortality data from one community with the same kind of data from another, it is necessary first to control for differences in the age composition of the communities being compared. This is accomplished by age- adjusting the data, a statistical manipulation usually performed by the professionals responsible for collecting and cataloging health data.  Aggregate data – Aggregation of data combines annual data gathered over a multi-year period, usually three or five years. The practice of presenting data that are aggregated avoids the instability typically associated with using highly variable year-by-year data consisting of relatively few cases or deaths. It is particularly important to aggregate data for smaller jurisdictions like Person County. Aggregating annual counts over a five year period before calculating a rate is a method commonly used by the NC State Center for Health Statistics (NCSCHS). Sometimes even aggregating data is not sufficient, so the NCSCHS recommends that all rates based on fewer than 20 events—whether covering an aggregate period or not—be considered “unstable”, and interpreted only with caution.  Morbidity - Morbidity as used in this report refers generally to the presence of injury, sickness or disease (and sometimes the symptoms and/or disability resulting from those conditions) among the living population. Morbidity data usually is presented as a percentage or a count, but not a rate.  Prevalence – Prevalence refers to the number of existing cases of a disease or health condition in a population at a defined point in time or during a defined period. Prevalence is usually expressed as a proportion, not a rate.  Incidence - Incidence is the population-based rate at which new cases of a disease occur and are diagnosed. It is calculated by dividing the number of newly diagnosed cases of a disease or condition during a given period by the population size during that period. Typically, the resultant value is multiplied by 100,000 and is expressed as cases per 100,000; sometimes the multiplier is a smaller number, such as 10,000.  Pregnancy rate – The pregnancy rate is the number of pregnancies per 1,000 women of target reproductive age. In this report, the target ages are “all women of reproductive age” (15-44 years) and “teen women” (15-19 years). 113 26 HEALTH RANKINGS Each year for more than 20 years, America’s Health Rankings™, a project of United Health Foundation, has tracked the health of the nation and provided a comprehensive perspective on how the nation and each state measures up. America’s Health Rankings are based on several kinds of measures, including determinants (socioeconomic and behavioral factors and standards of care that underlie health and well-being) and outcomes (measures of morbidity, mortality, and other health conditions). For the purposes of this CHA report, North Carolina’s ranking is important because it adds a national perspective to these comparisons. The table below shows where NC stood in the 2013 rankings relative to the “best” and “worst” states, and those states ranked on either side of NC. Note that first ranked (Hawaii) is best and 50th ranked (Mississippi) is worst. Rank of North Carolina in America’s Health Rankings (2013) Source: United Health Foundation, 2013. America's Health Rankings; http://www.americashealthrankings.org. County Health Rankings The Robert Wood Johnson Foundation, collaborating with the University of Wisconsin Population Health Institute, produces annual health rankings for the counties in all 50 states. In this project, each state’s counties are ranked within the state according to health outcomes and the health factors that determine a county’s health. The following table presents the 2014 county rankings for Person County and its comparator. In 2014, Person County was ranked 32nd in the state of NC in terms of health outcomes, due mostly to shortened life expectancy, and 48th in terms of health factors, in which category health behaviors and clinical care contributed most to the lower rank. These parameters will be discussed more fully later in this report. County Health Rankings (2014) Source: County Health Rankings and Roadmaps, 2014. University of Wisconsin Population Health Institute; http://www.countyhealthrankings.org/app/north-carolina/2014/rankings/outcomes/overall. Overall Determinants Outcomes Diabetes Smoking Obesity Infant Mortality Hawaii 1 2 2 7 3 3 24 Michigan 34 33 38 34 39 40 39 North Carolina 35 34 36 33 33 33 40 Texas 36 36 29 35 20 32 22 Mississippi 50 48 49 49 44 49 50 Location National Rank (Out of 50)1 114 27 MATERNAL AND INFANT HEALTH Pregnancy Rates Overall Pregnancy Rate As is true for NC as a whole, the overall pregnancy rate for women of childbearing age (15-44) in Person County has been falling, decreasing by 20% between 2008 and 2012. Statewide, over the same period, the overall pregnancy rate fell by 14%. In 2012, the overall pregnancy rate in Person County was 65.1 pregnancies per 1,000 women, 10% lower than the state rate of 72.1. When stratified by race, it is apparent that between 2010 and 2012 overall pregnancy rates in Person County fell among white (by 19%) and African American (by 25%) non-Hispanic women as well as among Hispanic women (by 25%). However, in 2012, the overall pregnancy rates for African American non-Hispanic women (78.7) and Hispanic women (78.1) in Person County both were approximately 34% higher than the comparable rate (58.2) among white non- Hispanic women in (49). Teen Pregnancy Rate Pregnancy rates among Person County teens (ages 15-19) also fell between 2008 and 2012, as they did statewide. In Person County, the decrease over that period was 31%; statewide the decrease was 32%. In 2012, the teen pregnancy rate in Person County was 48.6 pregnancies per 1,000 teen females, 23% higher than the state rate of 39.6. When stratified by race, it is apparent that between 2010 and 2012 teen pregnancy rates in Person County fell among both white (by 30%) and African American (by 14%) non-Hispanic teens. (Pregnancy rates among Hispanic teens were unstable and are not presented here.) However, in 2012, the overall pregnancy rate for African American non-Hispanic teens in Person County (82.9) was 71% higher than the comparable rate (32.6) among white non-Hispanic teens in the county (16). In terms of numbers rather than rates, teen pregnancies in Person County fell from 93 in 2008 and 83 in 2010 to 58 in 2012 (50). Pregnancy Risk Factors High Parity and Short-Interval Births According to NCSCHS, a birth is high parity if the mother is younger than 18 when she has had one or more births, or aged 18 or 19 and has had two or more births, or is 20-24 and has had four or more births, etc. A short-interval birth involves a conception occurring less than six months since the last birth. High-parity and short-interval pregnancies can be a physical strain on the mother and sometimes contribute to complicated pregnancies and/or poor birth outcomes. Although the frequency of high parity births among Person County women under the age of 30 fell 5% between 2005-2009 and 2008-2012, the 2008-2012 county figure was 8% higher than the comparable NC figure. Among Person County women age 30 or older, the frequency of high parity increased 13% between 2005-2009 and 2008-2012, and in the latter period was 15% higher than the comparable NC figure (24.7 vs. 21.5, respectively) (51). The frequency of short-interval births in Person County increased 6% between 2005-2009 and 2008-2012, and in 2008-2012 was 10% higher than the comparable NC figure (14.2 vs. 12.9, respectively) (52). 115 28 Lack of Early Prenatal Care Good pre-conception health and early prenatal care can help assure women the healthiest pregnancies possible. The percent of pregnant women in Person County who received early prenatal care (i.e., prenatal care in the first three months) of their pregnancies exceeded the comparable state figure in every year from 2006 through 2009. Beginning in 2011, the percentage in Person County fell dramatically, from 90% in 2010 to approximately 60% in 2011 and 2012. Indeed, the comparable figures for the state and Bladen County also fell over that period. It is unclear whether this jurisdiction-wide negative trend is linked to a change in the way the state handles prenatal care data or some other common factor (53). Smoking During Pregnancy Smoking during pregnancy is an unhealthy behavior that may have negative effects on both the mother and the fetus. Smoking can lead to fetal and newborn death and contribute to low birth weight and pre-term delivery. The percent of births to mothers who smoked during pregnancy was higher in Person County than in either Bladen County or NC as a whole in 2007, 2008, 2011 and 2012. Worse, the percent of births to Person County mothers who smoked during pregnancy rose 22% between 2009 and 2012, and rose 42% overall between 2006 and 2012, trends definitely in the wrong direction (54). Birth Outcomes Low and Very Low Birth Weight Births Low birth weight can result in serious health problems in newborns (e.g., respiratory distress, bleeding in the brain, and heart, intestinal and eye problems), and cause lasting disabilities (mental retardation, cerebral palsy, and vision and hearing loss) or even death (55). The overall frequency of low birth weight (≤ 5.5 lbs.) births in Person County increased 1% between 2005-2009 and 2012, and the overall frequency of very low birth weight (≤ 3.3 lbs.) births decreased 5% over the same period. When stratified by race, a clear disparity in these birth outcomes emerges. In 2008-2012, the frequency of low birth weight births among white non-Hispanic women in Person County was 6.3%, while among African American non-Hispanic women the comparable figure was 17.2%. The frequency of very low birth weight births among white non-Hispanic women in Person County was 2.0%, while among African American non- Hispanic women the comparable figure was 4.9%; thus the frequencies of both low and very low birth weight births among African American non-Hispanic women were more than twice the comparable frequencies among white non-Hispanic women. (Birth weight frequencies for Hispanic women in Person County were unstable and are not presented here.) In 2008-2012, the frequencies of low and very low birth weight births in Person County overall and among African American non-Hispanic women exceeded the comparable state figures (56). Infant Mortality The infant mortality rate is the number of deaths of infants under one year of age per 1,000 live births. The infant mortality rate in Person County decreased 30% between 2005-2009 and 2008-2012. For 2008-2012, the overall infant mortality rate in Person County was 6.5 infant deaths per 1,000 live births, 13% lower than the comparable state average of 7.5 (57). While the current Person County infant mortality rate is better than the state average, it bears noting that the infant mortality rate in NC was among the 10 worst of the 50 states throughout the period covered by the statistic. 116 29 When stratified by race, it is apparent that the infant mortality rate is much higher among African American non-Hispanic women regardless of jurisdiction. In both Person and Bladen counties for the period 2008-2012 the number of deaths among white non-Hispanic infants were too few to yield a stable rate. However, in Person County 79% of the infant deaths (11 of 14) occurred among African American non-Hispanic babies, yielding an infant mortality rate of 16.7, more than 2½ times the overall rate in the county. In Bladen County, 67% of the infant deaths (10 of 15) occurred among African American non-Hispanic babies, an infant mortality rate of 15.3, and nearly twice the overall rate in the county. Statewide, the infant mortality rate among African American non-Hispanic babies for 2008-2012 was 14.0, almost twice the overall rate and 2½ times the rate among white non-Hispanic infants (58). LIFE EXPECTANCY AND LEADING CAUSES OF DEATH Life Expectancy According to data shown in the table below, life expectancies for persons born in 2010-2012 in Person County were lower in all categories than the comparable state averages. Note, however, that life expectancies in Person County improved in all categories except females between 1990-1992 and 2010-2012. Life Expectancy at Birth, by Gender and Race Source: NC State Center for Health Statistics, County-level Data, Life Expectancy, State and County Estimates, Life Expectancy: North Carolina 1990-1992 and 2010-2012, State and County; http://www.schs.state.nc.us/schs/data/lifexpectancy/. Leading Causes of Death The following four tables summarize information on the leading causes of death in Person County. The source for these tables is a PowerPoint presentation summarizing CHA data that was prepared by the CHA consultant and is appended to this report. The data on which they are based is also appended to this report. According to the table below, 2008-2012 mortality rates in Person County exceeded the comparable rates statewide for 10 of the 15 leading causes of death. 117 30 Leading Causes of Death in Person County 2008-2012 The next table shows how the rank order of the leading causes of death in Person County shifted between 2005-2009 and 2008-2012. From this data it is clear that mortality rates for most causes of death improved over the interval cited, but rates for three worsened: chronic lower respiratory disease, Alzheimer’s disease, and suicide: Leading Causes of Death in Person County 2008-2012 and Change from 2005-2009 Although analysis of the data in the next table is hampered by numerous suppressed unstable rates, it does appear that males disproportionately suffer mortality from several causes of death: total cancer, heart disease, chronic lower respiratory disease, unintentional non-motor vehicle injury, diabetes, and especially pneumonia and influenza. The table also illustrates that unintentional non-motor vehicle injury and pneumonia and influenza rank significantly higher among men than among women as leading causes of death in Person County. 118 31 Leading Causes of Death in Person County 2008-2012, by Gender As shown in the following table, African Americans in Person County suffer disproportionate mortality for several of the leading causes of death: total cancer, heart disease, stroke, and especially diabetes, with the mortality rate for African American non-Hispanics three times the rate for white non-Hispanics. Note that racially stratified data is not available for many leading causes of death due to below-threshold numbers of deaths and suppressed unstable rates. Leading Causes of Death in Person County 2008-2012, by Race Each age group tends to have its own leading causes of death. Note that for this purpose, it is important to use non-age adjusted death rates. In the period 2008-2012, the leading cause(s) of death in each of the age groups in Person County were as follows (59): 119 32  Age Group 00-19: Conditions originating in the perinatal period  Age Group 20-39: All other unintentional injuries (i.e., non-motor vehicle injuries)  Age Group 40-64: Cancer – all sites  Age Group 65-84: Cancer – all sites  Age Group 85+: Diseases of the heart The next table, also from the consultant’s PowerPoint presentation, summarizes mortality rate trends in Person County for the 15 leading causes of death. The summary arrow describes the direction of slope of a regression line calculated using the eight rolling five-year aggregate mortality rates in the period from 2001-2005 through 2008-2012. A downward arrow indicates a falling slope/rate; an upward arrow indicates a rising slope/rate. Two upward arrows indicates a rising rate that has doubled (or more) since the initial period of the data. It is apparent from this data that over the period cited mortality rates in Person County improved overall for 9 of the 15 leading causes of death, and were comparatively unchanged in one. Unfortunately, rates increased overall for five causes of death: diabetes, Alzheimer’s disease, septicemia, chronic liver disease and cirrhosis, and homicide. Trends of Change in the Leading Causes of Death in Person County Despite a decreasing mortality trend, total cancer was the leading cause of death in Person County in the 2008-2012 period, and the community ranked cancer as the most significant health problem on the 2014 Person County Community Health Survey (60). Examining incidence and mortality rate trends for site-specific cancers is helpful in understanding more about the problem of cancer in the community. The following table from the consultant’s PowerPoint presentation summarizes trends in the incidence and mortality rates for five site- specific cancers: lung cancer, prostate cancer, breast cancer, colorectal cancer, and pancreas cancer. The incidence data covers the period from 1996-2000 through 2007-2011 and the mortality rate data covers the period from 2001-2005 through 2008-2012. The symbol protocol is the same as that used in the table above. A “double down” arrow indicates a rate that has halved since the beginning of the period covered. 120 33 Trends of Change in Cancer Incidence and Mortality in Person County It is difficult to fully interpret incidence data without information about cancer screening activities, since screenings sometimes raise incidence rates by discovering cancer cases that might otherwise go unnoticed for some period of time. A rise in incidence connected to screening is not necessarily a bad thing, since the resulting figure may include numerous cases that were caught early and treated. The data above indicate that incidence has risen for lung and colorectal cancers. While screenings for colorectal cancer are common, there is no routine lung cancer screening mechanism. The table above also shows that mortality has decreased over time for prostate, colorectal and pancreas cancers; unfortunately, the mortality rate trend for lung cancer and breast cancer increased over the time period cited. The rise in lung cancer incidence and mortality is not surprising, since one major cause of lung cancer, smoking, remains a problem in Person County. As illustrated in the data on smoking during pregnancy, pregnant women in Person County smoke at a frequency almost twice the state average, and the local frequency has risen 22% over the past three years. The hospital discharge rate for lung neoplasms in Person County exceeded the comparable state rate in six of the past seven years, and the local rate was almost twice the state rate in 2012 (61). In Person County, men have had a higher lung cancer mortality rate than women for the past eight aggregate periods, but the mortality rate gap between men and women has closed somewhat as lung cancer mortality has increased for women and decreased for men (62). Interestingly, smoking has fallen from third place in 2007 to fifth place in 2014 on the list of most significant “unhealthy behaviors” in Person County according to Community Health Survey results (60). Other Community Health Survey results indicate that the public may be unaware of or possibly misinformed about the significance of certain health problems that result in many deaths and high mortality rates in Person County. The table below from the consultant’s PowerPoint presentation shows a rank-order listing of the community health problems identified by respondents in the 2014 and 2011 Person County Community Health Surveys. In each year cited, the public correctly identified cancer, heart disease, and diabetes as among the most significant community health problems, but “underrated” the significance of stroke, lung disease and non-motor vehicle injuries. These “disconnects” between opinion and fact are opportunities for community health education. 121 34 Rank Order of Community Health Problems in Person County Community Health Survey MORBIDITY AND CHRONIC DISEASE Diabetes As noted previously, diabetes was the sixth leading cause of death overall in Person County in 2008-2012. It was the fourth leading cause of death among African American non-Hispanics in the county, at a mortality rate three times the comparable rate among white non-Hispanics. Although not racially stratified, data available from the Centers for Disease Control and Prevention (CDC) describes the estimated prevalence of diagnosed diabetes among adults age 18 and older at the county level. According to this data (derived from the BRFSS) the prevalence of adult diabetes in Person County increased 18% overall between 2006 and 2011; the comparable figures for Bladen County and NC were 27% and 6%, respectively. The average 6-year prevalence of diagnosed adult diabetes in Person County over that period was 10.4%; the comparable figures for Bladen County and NC were 11.5% and 9.1%, respectively (63). For each of the past three CHA cycles the Person County Community Health Survey has asked respondents whether they had been medically diagnosed with any of a list of diseases, including diabetes (not during pregnancy). The percentage of respondents replying “yes” to a diabetes diagnosis was 13.1% in 2007, 12.0% in 2011, and 15.8% in 2014. When stratified by gender, the “yes” response percentages in 2014 were similar among men and women, 15.0% and 14.3%, respectively. However, when the 2014 survey data was stratified by race, the “yes” response percentages were very disparate: 11.0% for whites and 28.3% for African Americans (60). As noted previously, survey respondents identified the significance of diabetes as a leading community health problem, perhaps because many of them were sufferers. 122 35 Overweight and Obesity Overweight and obesity are well-recognized as precursors to many health problems, including diabetes. As with diabetes, the CDC describes the estimated prevalence of diagnosed obesity in adults age 18 and older at the county level. According to this data (also derived from the BRFSS) the prevalence of diagnosed obesity in Person County increased only 2% between 2006 and 2011; the comparable figure for Bladen County was 22%. (Similar state-level data is not available from the source.) The average 6-year prevalence of diagnosed obesity among adults in Person County over that period was 32.3%; the comparable figure for Bladen County was 33.7% (64). Other local data would appear to corroborate that overweight and obesity are significant health problems in Person County. In the fall of 2012, the Farm Bureau Insurance Company sponsored a Healthy Living for a Lifetime health screening event in the county that drew 163 participants. Among the parameters measured were height and weight, and the calculation of body mass indices. Below are the results of the BMI portion of the assessment (65).  Average BMI of all participants – 30 kg/m2  Percent of participants at low risk (18.5-24.9 kg/m2) – 25.2%  Percent of participants at moderate risk (25-29.9 kg/m2) – 27.0%  Percent of participants at high risk (>29.9 kg/m2) – 47.9% According to results of a Marketing Report prepared for Person County in 2013, 35% of adult survey respondents reported that a doctor had told them that they were either overweight (32%) or obese (3%) (66). Finally, according to results from the 2014 Person County Community Health Survey, 42.8% of 611 adult respondents reported that they had been diagnosed by a doctor, nurse or other health professional as either overweight or obese (60). While the three local data sources described above provided only limited stratified data it nevertheless appears that the population groups identified as most at risk for overweight and obesity were women (according to one report specifically those between the ages of 35 and 64) and African Americans. As noted previously, respondents from the three most recent Person County Community Health Surveys have consistently ranked overweight/obesity among the top three leading health problems in the community. Furthermore, during the same three surveys the community usually identified the behaviors contributing to overweight and obesity—poor eating habits, and lack of physical activity—among the top four most significant “unhealthy behaviors” in the county (60). While data on childhood obesity is far sparser than data on adult obesity, the existing data appears to indicate that overweight and obesity are as pervasive among toddlers as among adults. According to 2012 data from NCNPASS (North Carolina Nutrition and Physical Activity Surveillance System), 17% of 2-4 year olds in the NPASS program in Person County were overweight, and 15% were obese. For comparison, in Bladen County 15% of 2-4 year old participants were overweight and 16% were obese, and statewide 15% were overweight and 15% were obese (67). Complications from overweight and obesity include not only diabetes but also heart disease, high cholesterol, and high blood pressure. Each of these conditions is prevalent in the Person 123 36 County community, as indicated by results of Person County Community Health Surveys. In the 2014 survey, 5% of the respondents reported they had been diagnosed with angina or heart disease; this figure compares to a 6% response frequency in 2011. Respondents reported a diagnosis of high cholesterol at a frequency of 32% in both 2014 and 2011 and 30% in 2007. Finally, 37% of respondents reported a diagnosis of high blood pressure in 2014, compared to 32% in 2011 and 30% in 2007 (60). Communicable Disease Sexually transmitted infections (STIs) are the most common communicable diseases in Person County. Among STIs, chlamydia is the most prevalent, followed by gonorrhea. However, according to state data, Person County incidence rates for both chlamydia and gonorrhea were consistently lower than comparable rates for the state overall from 2009 through 2012. In 2012 the Person County incidence rate for chlamydia infection was 431.4 new cases per 100,000 population. The comparable chlamydia rate statewide was 524.1 (68). The NC Communicable Disease Branch provides the following disclaimer to these chlamydia incidence data: Note: chlamydia case reports represent persons who have a laboratory-confirmed Chlamydial infection. It is important to note that Chlamydial infection is often asymptomatic in both males and females and most cases are detected through screening. Changes in the number of reported cases may be due to changes in screening practices. The disease can cause serious complications in females and a number of screening programs are in place to detect infection in young women. There are no comparable screening programs for young men. For this reason, Chlamydia case reports are always highly biased with respect to gender. The North Carolina STD Surveillance data system has undergone extensive changes since 2008 when North Carolina implemented North Carolina Electronic Disease Surveillance System (NC ESS). During this transition, Chlamydia morbidity counts for some counties may have been affected. Report totals for 2011 should be considered with this in mind. Reports are summarized by the date received in the Communicable Disease Surveillance Unit office rather than by date of diagnosis. In 2012 the gonorrhea incidence rate in Person County was 88.3 new cases per 100,000 population. The comparable rate statewide was 148.3 (68). The highest rates of gonorrhea have been found in African Americans, people 20 to 24 years of age, and women, respectively (69). The Person County Health Department, Communicable Disease Section is responsible by law for tracking cases of all communicable diseases. Below is a summary of the communicable disease cases identified in Person County over the period 2009 through 2013 (70).  There were from 8 to 20 foodborne illnesses reported annually over the period cited; of the total of 65 cases reported between 2009 and 2013, 28 (43%) were Campylobacter infections and 28 were cases of salmonellosis.  There were 927 total cases of sexually transmitted infections over the period cited, 80% of which were chlamydia infections.  Rocky Mountain spotted fever was the non-STI, non-foodborne communicable disease most frequently reported, totaling 34 cases in the period cited. 124 37 PREVENTION AND HEALTH PROMOTION NEEDS AND RESOURCES Access to and utilization of healthcare is affected by a range of variables including the availability of health insurance coverage, availability of medical and dental professionals, transportation, cultural expectations and other factors. HEALTH INSURANCE In most communities, citizens’ utilization of health care services is related to their ability to pay for those services, either directly or through private or government health insurance plans and programs. People without health insurance are often the segment of the population least likely to seek and/or to be able to access necessary health care. The table below summarizes the population (by age group) without health insurance of any kind for three biennia from 2006-2007 through 2010-2011. Prior to the advent of the Affordable Care Act the health insurance system in the US was built largely on employer-based insurance coverage, and any significant increase in the number of unemployed people usually led to an increase in the number of uninsured. With the advent of the Affordable Care Act, it is difficult to assess the current scope of the uninsured population, as available data all describes past circumstances which may no longer match reality. Interestingly, the table below does not show a significant increase in the percent of uninsured people in Person County in the three years after the start of the national recession in 2008. In fact, the percent uninsured in the county actually decreased in the period immediately following the start of the recession. This phenomenon was repeated in Bladen County; statewide the pattern of uninsured was more variable. Percent of Population Without Health Insurance, by Age Group North Carolina Institute of Medicine, NC Health Data, Uninsured Snapshots, Characteristics of Uninsured North Carolinians 2006-2011, http://www.nciom.org/nc-health-data/uninsured-snapshots/. The 2014 Person County Community Health Survey asked participants whether or not they had health insurance at the time of the survey (late spring, 2014). Among the 599 respondents who answered the question, 50 (8.3%) did not have health coverage at the time of the survey (60), a figure not even close to the admittedly dated figures in the table above. The smaller proportion of uninsured identified in the survey compared to the 2010-2011 data in the table may be due to a number of factors, including uneven distribution of survey participants (the survey was based on a convenience sample that reached predominately wealthier and employed residents), and an economy that had improved since 2010-2011. It is also possible that the lower survey figure was connected to persons having gained coverage through the Affordable Care Marketplace. 0-18 19-64 0-64 0-18 19-64 0-64 0-18 19-64 0-64 Person County 13.0 21.9 19.2 10.2 21.1 18.0 7.9 20.7 17.1 Bladen County 14.5 24.8 21.4 12.7 22.3 19.4 8.6 21.2 17.7 State of NC 11.3 19.5 19.5 11.5 23.2 19.7 9.4 1 23.0 1 18.9 1 2006-2007Location 2008-2009 2010-2011 125 38 Although the survey sample was sufficiently skewed to invalidate comparisons between stratified groups of respondents, it is still valid to examine patterns of response within single stratified categories. Among all 599 respondents (60):  A significantly higher percentage of African Americas (almost 19%) than whites (approximately 4%) were uninsured, and a much higher percentage of Hispanics (almost 57%) than non-Hispanics (approximately 5%) were uninsured.  As to age, 21% of those age 18-29, 10% of those age 30-49, 5% of those age 50-64, and 1% of those age 65 and older were uninsured. This data reflects the facts that persons over the age of 65 are all eligible for Medicare, and that persons in younger age groups are those most vulnerable to unemployment and lack of insurance.  Regarding education level, 17% of those with less than a high school diploma or GED, 13% of those with a high school diploma or GED, 9% of those with an Associate’s degree or vocational training, and 1% of those with a Bachelor’s degree or higher were uninsured. The proportion without health insurance decreases as education level increases relates to employment opportunities and concomitant insurance benefits available to those who are better educated.  As to income level, 45% of those with a household income below $20,000, 10% of those with household income between $20,000 and $40,000, and 3% of those with household income between $40,000 and $60,000 were uninsured. The proportion without health insurance decreases as income increases relates being able to afford and access health insurance benefits, either through employment or purchase.  Regarding employment status, 27% of the unemployed, 4% of those employed full-time, 35% of those employed part-time, 47% of homemakers, and 20% of the self-employed were uninsured. It is not surprising that the unemployed, part-time employed and self- employed lack health insurance. The high rate of lack of insurance among homemakers was something of a surprise, as the assumption is that most homemakers, if married, are covered by their spouse’s insurance. It will not be possible to fully assess the scope of lack of health insurance in Person County until the new health insurance paradigm initiated by the Affordable Care Act is well established. In the opposite case from poverty, which is worse among children, the percent of children who are uninsured is lower than the percent of adults. .The table above contains data showing that the percent of children age 0-18 without health insurance is much lower than the comparable percent for the 19-64 age group, and that the figure for children fell dramatically between 2006- 2007 and 2010-2011. This may be attributed perhaps to the fact that, as shown in the following table, enrollment in NC Health Choice (the program that provides insurance to children in low- income families who earn too much to qualify for Medicaid) has increased steadily over time in all three jurisdictions, but most in Person County. In Person County, enrollment in NC Health Choice increased from 58% in 2009 to 98% of eligible children in 2013. Enrollment in NC Health Choice Source: NC Division of Medical Assistance, Statistics and Reports, N.C. Health Choice Monthly Enrollment/Exemption Reports, 2009-2013; http://www.ncdhhs.gov/dmA/ca/nchcenroll/index.htm. 126 39 HEALTH CARE RESOURCES Health Care Providers According to County Health Rankings, cited previously, Person County was ranked 54th in NC in terms of clinical care, the middle of the range statewide. Further, the ratios of providers to population for major groups of health care professionals in Person County are also lower than state averages: the ratios for MDs, primary care MDs, registered nurses, dentists, and pharmacists were lower than comparable state or national averages in 2009, 2010, and 2011, the three most recent years for which data is available (71). This data would seem to indicate substandard health care access in Person County. However, both of these types of county-focused data are somewhat misleading in terms of describing the overall accessibility of health care to the Person County population. Person County is adjacent to Durham County, home to a major medical center, a large community hospital, specialty hospitals, and numerous private practices; it is also near Chapel Hill (Orange County) and Raleigh (Wake County) which boast similar resources. It is a fact that many Person County residents go outside of the county to access medical care; presumably some of their outreach is deliberate. When a question on the 2014 Person County Community Health Survey asked whether respondents sought health care outside of Person County, fully 16% of respondents answered “yes” (60) According to 2011 data from the Sheps Center for Health Services Research, Person County has at least one provider in most categories of health professionals listed. Unrepresented groups of specialists included general practitioners, obstetricians/gynecologists, certified nurse midwives, podiatrists and practicing psychologists (72). Of these, the most important gap would appear to be lack of providers who can attend a woman throughout pregnancy and delivery. Prenatal services are available in the county through the Health Department and one other provider. However, women must go out of county to deliver their babies When asked whether they had difficulty accessing needed medical care, roughly 14% of respondents to the 2007, 2011 and 2014 Person County Community Health Surveys answered “yes”. Among those who had access problems, over 40% in each survey cited “lack of insurance” as the main barrier, followed by “cost (i.e., deductible or co-pay) too high” (60). Accessibility of health care did not appear to be a major problem for the vast majority of survey respondents. There are only nine dentists in Person County (38), and many of their dental practices do not accept Medicaid patients. Accessing dental care therefore may be a particularly difficult problem for Medicaid enrollees since only three dental practices in Person County accept Medicaid and/or NC Health Choice clients, and all have limits on how many Medicaid or Health Choice clients they will accept (73). Health Care Facilities Hospital Person County is home to Person Memorial Hospital, a self-described “full-service”, accredited hospital which is part of the Duke LifePoint system of hospitals. The facility is licensed for 110 beds (50 acute care beds, including intensive care beds, and 60 extended care beds). The 127 40 hospital provides both inpatient and outpatient services, including an emergency department (74). There are no obstetrician/gynecologists on staff at the local hospital. Health Department The Person County Health Department, located in Roxboro, cares for men, women and children by providing comprehensive services focused on wellness, education and prevention. Agency programs include: disease prevention and control, preparedness and response to emergent diseases and events, environmental health, home health, hospice, WIC, and personal health programs, such as OB/GYN services and child health. The Health Department also employs Certified Application Counselors to assist the uninsured in enrolling or to answer questions about health insurance through the Affordable Care Marketplace (75). Federally-Qualified Health Center Currently there is one FQHC in Person County: Person Family Medical and Dental Centers, Inc. (76). The center has two facilities, a medical and dental practice in Roxboro, and a dental-only facility in Yanceyville. Medical staff offer primary health care and facilitate access to secondary health care support with special attention to the needs of underserved populations. Both facilities accept Medicaid/NC Health Choice, Medicare, any major insurance plan, and self-pay on a sliding scale based on the patient’s income and family size (77). Emergency Medical Services Person County EMS, operated by the county government, responds to a variety of calls, including medical conditions but also crimes, fires, false alarms, etc. Medically-related calls represented approximately 89% of EMS response activities over the past three years (78). School Health The local educational authority in Person County, Person County Schools, employs all school health nursing staff. Student’s needs range from first aid for cuts, acute illness nursing, and hygiene counseling to chronic disease management, grief counseling, and suicide prevention. The most recent (SY2011-2012) ratio of school nurses to students in Person County schools was 1:985; during the same school year the ratio for the state was 1:1,179. The recommended ratio is 1:750 (79). Long-Term Care Facilities As of July 2014, there were two state-licensed family care homes, three adult care homes/homes for the aged, and one nursing home in Person County, together offering 366 beds (80). Person Memorial Hospital also maintains 60 extended care beds, bringing the county total to 426 (40). As was discussed previously, this number of beds may not be adequate for a county whose population over the age of 65 is projected to grow by over 60% in the next 15 years. Home Care, Home Health and Hospice Services An alternative to institutional care preferred by many disabled and senior citizens is to remain at home and use community in-home health and/or home aide services. This report prefers to cite only those in-home health and/or home aide services that are licensed by the state of NC. Note that there may be additional providers in Person County that refer to themselves as “home 128 41 health service (or care) providers” that are not licensed by the state and are not named in this report. As of July 2014, there were four licensed home care, home health or hospice providers in Person County, all of them with home offices in Roxboro (81). In addition, the Person County Department of Social Services provides a number of home-care related services for their clients who qualify for other governmental services (82). Given the projected growth of the county, it would be prudent to more fully assess the adequacy of these alternatives to institutional care of the elderly and disabled as the county grows. Mental Health Services Providers and Service Facilities At the time this report was prepared, the local management entity/managed mental health care organization (LME/MCO) for Person County was Cardinal Innovations Healthcare Solutions, which is headquartered in Kannapolis, NC but serves a total of 16 counties in central NC. It maintains an OPC (Orange-Person-Chatham) Operations Center in Chapel Hill with a local number but access to the network’s 24-hour access/crisis number (83). During FY2012-13 there was a total of 748 contracted providers throughout the Cardinal Innovations provider network; however, only nine of these providers were physically located in Person County (84). It is unclear whether the paucity of local providers hinders access to and utilization of mental health services by Person County residents. It is also unclear whether the public knows about the local LME or how to access it. When respondents to the 2014 Person County Community Health Survey were asked to where they might refer a friend or family member with a mental health or drug/alcohol problem, fully 15% said they didn’t know. While most recommended a specific mental health facility or a mental health practitioner in private practice, a significant proportion chose referral answers outside of the network of mental health professionals, such as a member of the clergy, a support group or a school counselor. Knowledge about mental health services should be important to Person County citizens, since 23%-27% of respondents to the past three Community Health Surveys report they have been diagnosed with depression (60). As of February, 2014, there were a total of 16 state-licensed facilities in Person County offering supervised living, day services or sheltered workshops for developmentally disabled adults. There were also two licensed substance abuse programs, neither of which served children or youth (85). Other Healthcare Resources As of July 14, 2014, there were no independent, free-standing ambulatory surgical facilities in Person County (86), but Person Memorial Hospital offered same-day surgery services (40). There was one licensed cardiac rehabilitation facility (operated by Person Memorial Hospital) (52) and one Medicare-approved dialysis facility (87). Since diabetes is one of the county’s leading health problems, especially in the African American community, and high blood pressure is prevalent according to the 2014 Person County Community Health Survey (60), complications from these conditions, including kidney failure, might be expected to become more prevalent as well. The community should investigate the need for kidney dialysis now and in the future and determine if this one dialysis facility is adequate. 129 42 Recreational Facilities Person County has the distinction of being the oldest county recreation department in NC. Programs were begun in the 40's with full funding occurring in 1961. Person County Recreation, Arts, and Parks Department operates 12 parks and playing fields and a cultural arts center, and offers a variety of classes and programs through its Athletics, Cultural Arts, and Special Programs departments, as well as programming through Mayo Park (88). However, there is no indoor or outdoor public swimming pool in the county. The Senior Center has been temporarily relocated. This facility does have a fitness center available. Exercise classes are also offered through the Senior Center, most of which are held at other locations. Disease Prevention and Health Promotion Resources in Person County The following is a list of some of the prevention and health promotion resources in Person County. It is by no means exhaustive of everything available. These resources are primarily those with which public health has been directly involved. The list highlights services, programs, partnerships, community resources and facilities, and a resource guide, all of which has and will continue to play an important role in addressing the county’s health priorities. Living Healthy Self-Management Program - Living Healthy is a skill-building workshop series that helps people with one or more chronic conditions (e.g. diabetes, chronic pain, hypertension, cancer, arthritis) learn to manage their condition and their life. This workshop involves 6 weekly sessions, each one 2 ½ hours long. Living Healthy sessions address action planning, nutrition, fitness, medication management, communication with health care providers, dealing with fatigue and pain, fall prevention, etc. as strategies for self-managing chronic conditions. This evidence- based program was developed by Stanford University. Living Healthy with Diabetes Self-Management Program - Living Healthy with Diabetes is structured similarly to the Living Healthy program. However, it more specifically targets people with type 2 diabetes. In addition to being taught many of the same concepts presented in Living Healthy, participants are also informed about counting carbohydrates, glucose monitoring, preventing hypoglycemia, etc. for managing blood sugar levels. Living Healthy with Diabetes is also an evidence-based program developed by Stanford University. Carbohydrate Counting/Meal Planning Workshop – This workshop is primarily for people with type 2 diabetes or pre-diabetes as well as their caregivers. It has also proven beneficial for health care professionals working with people with such conditions. Participants are made aware of sources of carbohydrates; recommended amounts of carbohydrates, proteins and fats per meal and snack; and how to put together meals within those recommendations. Each workshop consists of hands-on practice with meal planning. The workshop is led by a Registered Dietitian. Eat Smart, Move More Weigh Less – Eat Smart, Move More, Weigh Less is a weight- management program that uses strategies proven to work. Each lesson informs, empowers, and motivates participants to live mindfully as they make choices about eating and physical activity. This 15-week program provides opportunities for participants to track their progress and keep a journal of healthy eating and physical activity behaviors. Eat Smart, Move More, Weigh Less is an evidence-based program developed by North Carolina Public Health and North Carolina State University. 130 43 Joint Use Agreements – Recreational facilities are more accessible to county residents and organizations through joint use agreements. Person County Recreation, Arts, and Parks (PCRAP) have established a joint use agreement with Person County Schools for shared facility usage. PCRAP also makes the gymnasium at the Huck Sansbury Recreational Complex available to the public 5 days a week for walking and other activities. This complex is in a central location in the county. Local Farmers’ Markets – Two farmers markets make fresh, local foods more accessible. Both markets are centrally located in the county in an area identified as a food desert. Healthy Personians Initiatives - Healthy Personians is a certified community-based partnership that strives to assist the residents of Person County with establishing and maintaining healthy lifestyles. This partnership addresses health issues and concerns in the county through a variety of initiatives each year. Person County Medical Reserve Corps – Person County Medical Reserve Corps engages both medical and non-medical volunteers in times of emergency as well as everyday public health activities. Volunteers are involved in the community health assessment process as well as clinic and community-based health promotion activities such as immunization clinics, worksite screenings, community outreach and screenings, etc. Person County Resource Guide – Home Health and Hospice of Person County, a division of Person County Health Department, makes available a comprehensive resource guide of the many services and programs in the county. A plethora of health and human services resources for all ages are listed in the guide. It is available via hard copy and is posted on the Health Department’s website. For additional information on any of these resources contact Person County Health Department (336-597-2204). 131 44 COMMUNITY CONCERNS SUMMARY The 2014 Person County Community Health Survey solicited respondents’ concerns about community health problems, unhealthy behaviors, and non-health related issues. The 2014 survey was conducted primarily electronically, using Survey Monkey, but paper copies also were made available in both English and Spanish. A stratified convenience sample approach was used and collected responses from 624 citizens of the county. Despite attempts to prevent it, certain groups were either over-sampled or under-sampled. The 2014 survey respondent pool can be generally characterized as predominately female, ethnically diverse, older, more affluent, and more highly educated than the general population. (See Appendix 2, p. 2 for a more extensive comparison of survey respondents to US Census population data). Because the 2014 survey was supported by the same consultant involved in three previous surveys, it was possible to compare data from 2003, 2007, 2011, and 2014 surveys. Although year-to-year differences in response rates for questions on convenience-sample surveys such as these are not strictly comparable due to methodology and respondent differences, it is still instructive to note the broad similarities (or differences) in community responses over time. The tables below are from the consultant’s full 2014 CHA report, available on the Person County Health Department website. (The survey chapter from that report is attached as Appendix 2.) It is remarkable how little community concerns have changed over time. Consider the following: Health Concerns, Person County Community Health Surveys Health Concern 2007 2011 2014 Rank # % Rank # % Rank # % Cancer 1 412 62.8 1 538 69.2 1 499 80.1 Obesity/Overweight 3 344 52.4 2 494 63.5 2 384 61.6 Heart Disease/Heart Attacks 2 378 57.6 3 461 59.3 3 369 59.2 Substance abuse n/a n/a n/a n/a n/a n/a 4 351 56.3 Diabetes 4 321 48.9 4 411 52.8 5 342 54.9 Mental Health 7 239 36.4 6 284 36.5 6 206 33.1 Teenage Pregnancy 6 253 38.6 7 249 32.0 7 164 26.3 Alzheimer’s disease 1 n/a n/a n/a n/a n/a n/a 8 161 25.8 Aging Problems 5 313 47.7 5 378 48.6 n/a n/a n/a Lung Disease 10 109 16.6 9 118 15.2 9 135 21.7 Stroke 9 119 18.1 8 166 21.3 10 97 15.6 Motor Vehicle Injuries 2 11 106 16.2 12 99 12.7 11 77 12.4 Sexually Transmitted Diseases 8 120 18.3 10 104 13.4 12 64 10.3 Accidental injuries NOT involving vehicles 3 17 44 6.7 10 104 13.4 13 58 9.3 Kidney Disease 15 62 9.5 15 73 9.4 14 53 8.5 Infectious/Contagious Diseases 16 57 8.7 14 73 9.4 15 48 7.7 Dental Health 14 65 9.9 13 80 10.3 16 44 7.1 HIV/AIDS 13 87 13.3 17 46 5.9 17 30 4.8 Liver Disease 21 17 3.2 20 11 1.4 18 14 2.2 Other 22 14 2.1 19 15 1.9 19 12 1.9 Infant Death 20 36 5.5 21 7 0.9 20 7 1.1 1 Alzheimer's was included in the description of Aging Problems in previous years 2 Category was listed as Motor Vehicle Accidents in previous years 3 Category was "Other Injuries" in 2003 132 45 Since 2007, cancer consistently has been the most commonly identified health concern. The percentage of respondents selecting it has increased each year: 80.1% of participants chose it in 2014, up from 62.8% in 2007 and 69.2% in 2011. The second and third most commonly identified health problems have traded places: heart disease was the second most common health concern in 2007 and was third during the next two cycles. Obesity/overweight was third in 2007 and was ranked second in 2011 and 2014. More than half of respondents identify obesity/overweight as a health concern; in 2014 it was chosen by 61.6% of respondents. Heart disease was selected by 59.2% of 2014 Survey respondents. Substance abuse, not previously an option on the list of health concerns, was the fourth most commonly selected health concern in 2014, chosen by 56.3% of respondents. Diabetes was the fifth most commonly identified health concern in 2014; it ranked 4th in both 2007 and 2011. The percentage of respondents selecting it has increased each year: from 48.9% in 2007, to 52.8 in 2011, to 54.9% in 2014. The percentages of respondents choosing mental health as a concern have declined over time (from 36.4% in 2007 to 33.1% in 2014), as have the percentages of respondents selecting teenage pregnancy (38.6% in 2007, 32.0 in 2011, and 26.3% in 2014). Although the list of health concerns was very different in 2003 (when health concerns were listed together with unhealthy behaviors), cancer was chosen as a concern by 48.8% of respondents, obesity was chosen by 44%, teen pregnancy by 31.8%, and diabetes by 26.7%. Heart disease (co-listed with stroke) was ranked lower on the 2003 list, selected by 22.9%. Mental health was much lower on the list as well, selected by only 14.5% of respondents. While there have been some rank shifts in the list of community health problems over time, the five primary health issues of concern to the Person County community consistently include cancer, heart disease, overweight/obesity and diabetes. The survey also sought community input on the most important unhealthy behaviors in the community. Again, there has been little change in the ranking of unhealthy behaviors over time, as noted in the results table below: 133 46 Unhealthy Behaviors, Person County Community Health Survey Unhealthy Behaviors 2007 2011 2014 Rank # % Rank # % Rank # % Drug Abuse 1 540 81.1 1 585 75.2 1 520 83.5 Alcohol Abuse 2 494 74.2 2 522 67.1 2 390 62.6 Lack of exercise/poor physical fitness 7 229 34.4 3 399 51.3 3 360 57.8 Poor Eating Habits 4 307 46.1 3 399 51.3 4 340 54.6 Smoking/Tobacco Use 3 373 56.0 5 391 50.3 5 312 50.1 Lack of parenting skills n/a n/a n/a 6 266 34.2 6 266 42.7 Not going to doctor for preventive check-ups and screenings 5 267 40.1 7 247 31.7 7 218 35.0 Having unsafe sex 6 244 36.6 8 186 24.0 8 166 26.6 Reckless/drunk driving 8 188 28.2 8 186 24.0 9 147 23.6 Violent, angry behavior 9 147 22.1 10 171 22.0 10 115 18.5 Suicide 14 53 8.0 12 75 9.6 11 61 9.8 Not going to dentist for preventive checkups and cleaning 10 126 18.9 11 101 13.0 12 60 9.6 Poor preparation for disasters and emergencies n/a n/a n/a 15 44 5.7 13 45 7.2 Not using child safety seats 12 79 11.9 17 41 5.3 14 35 5.6 Not using seatbelts 11 103 15.5 13 67 8.6 15 29 4.7 Not getting prenatal care 13 76 11.4 14 46 5.9 16 27 4.3 Not getting immunizations to prevent disease 15 44 6.6 16 42 5.4 17 24 3.9 Since 2007, the most commonly identified unhealthy behavior was drug abuse, chosen consistently by more than 75% of the survey respondents; in 2014, 83.5% of participants selected it, the highest percentage since 2003. The second most commonly identified unhealthy behavior since 2007 has been alcohol abuse, though the percentage of respondents selecting it decreased each year: from 74.2% in 2007, to 67.1% in 2011, to 62.6% in 2014. Lack of exercise was of relatively greater concern to more recent survey respondents (who ranked it #3 in both 2011 and 2014) compared to 2007 respondents (who ranked it #7). An increasing percentage of participants selected it: 34.4% in 2007, 51.3% in 2011, and 57.8%, in 2014. Poor eating habits and smoking/tobacco use were the next most commonly identified unhealthy behaviors, selected by more than 50% of respondents in both 2011 and 2014. The lack of parenting skills option was identified as an important unhealthy behavior by an increasing percentage of respondents: 34.2% in 2011 and 42.7% in 2014. Although, as mentioned earlier, the 2003 list of unhealthy behaviors looked quite different, some similarities in responses are notable: drug use was the second most commonly identified issue, selected by 44.6% of respondents, and alcohol abuse was chosen by 36.4% of respondents. Tobacco use was selected by 25.1% of respondents. Lack of exercise and poor eating habits were lower on the list, identified by 23.9 and 18.1% of respondents, respectively. As with responses to the question about community health problems, there has been some rank shifts in the list of unhealthy behaviors over time, but the five primary unhealthy behaviors of 134 47 concern to the Person County community consistently include drug abuse, alcohol abuse, poor eating habits, and smoking. Finally, the survey also sought community input on the most important non-health issues in the community. Again, there has been little change in the ranking of unhealthy behaviors over time, as noted in the results table below: Community Issues, Person County Community Health Survey Community Concerns 2007 2011 2014 Rank # % Rank # % Rank # % Unemployment/underemployment 1 340 51.4 1 482 62.0 1 343 55.1 Low income/poverty 4 254 38.4 5 274 35.2 2 316 50.7 Gang activity 2 291 44.0 2 352 45.2 3 240 38.5 Affordability of health services 3 280 42.4 3 312 40.1 4 207 33.2 Crime 1 17 86 13.0 4 307 39.5 4 207 33.2 Lack of recreational facilities 8 155 23.4 9 162 20.8 6 183 29.4 Dropping out of school 5 238 36.0 7 206 26.5 7 173 27.8 Lack of counseling/mental health services/ support groups n/a n/a n/a 11 137 17.6 7 173 27.8 Availability of healthy food choices in restaurants/grocery stores 9 145 21.9 9 162 20.8 9 167 26.8 Neglect and abuse 7 197 29.8 8 189 24.3 10 141 22.6 Lack of/inadequate health insurance 6 213 32.2 6 208 26.7 11 138 22.2 Affordability of housing 2 12 131 19.8 12 130 16.7 12 116 18.6 Racism/discrimination 13 107 16.2 14 101 13.0 13 113 18.1 Transportation options 11 134 20.3 17 74 9.5 14 93 14.9 Availability of child care 10 142 21.5 15 81 10.4 15 80 12.8 Pollution (air, water, land) 16 87 13.2 16 75 9.6 16 76 12.2 Unsafe schools n/a n/a n/a 13 119 15.3 17 68 10.9 Lack of healthcare providers 15 91 13.8 18 67 8.6 18 57 9.1 Unsafe/unmaintained roads n/a n/a n/a 19 59 7.6 18 57 9.1 Lack of culturally appropriate services for minorities 18 78 11.8 23 46 5.9 20 52 8.3 Disaster preparedness 14 97 14.7 21 44 6.9 21 42 6.7 Homelessness 19 76 11.5 22 49 6.3 22 41 6.6 Animal control issues/rabies 20 68 10.3 20 55 7.1 23 32 5.1 1 – Listed as “Violent Crime” in 2007 2 – Listed as “inadequate/Unaffordable Health Insurance” in 2007 In each of the three surveys presented, the most commonly identified community issue was unemployment/underemployment, with more than half of respondents selecting it among their top five issues. A lower proportion of respondents selected it in 2014 (55.1%) than in 2011 (62.0%). (Note, however, that the unemployed segment of the Person County population was significantly under-sampled in the 2014 survey.) In 2014, the second most commonly chosen community concern (~50%) was low income/poverty, which has risen up the ranks since 2007 and 2011, when it ranked 4th and 5th respectively and garnered approximately 36% of the responses. Gang activity was ranked as the third greatest community concern in 2014, chosen by 38.5% respondents, a decrease from approximately 45% in both 2007 and 2011. 135 48 The lack of/inadequate health insurance option fell from a ranking of 6th in 2007 and 2011 to 11th in 2014, having been chosen by 32.2% of respondents in 2007, 26.7% in 2011, and 22.2% in 2014. Lack of recreational facilities has risen in significance among survey respondents since 2007, when 23.4% of respondents listed it among concerns; in 2014, 29.4% selected it. Although the 2003 Community Issues list was quite different and had fewer options, underemployment topped the list, with 76.6% of respondents selecting it. Health insurance affordability was second that year, chosen by 69.0% of the respondents, followed by low income/poverty at 52.5% and dropping out of school at 50.0%. As with responses to the questions about community health problems and unhealthy behaviors, there have been some rank shifts in the list of non-health community issues over time, but the five primary non-health issues of concern to the Person County community consistently include unemployment/underemployment, low income/poverty, gang activity, affordability of health services, and crime. 136 49 COMMUNITY PRIORITIES PRIORITY SELECTION PROCESS After receiving primary and secondary data reports from the CHA Public Health Consultant, the local CHA team was involved in a series of meetings to work towards establishing priorities. The importance of broad community involvement from the public, stakeholders, partners, and diverse populations was emphasized. It was concluded that the most feasible way to achieve this was to use a priority setting survey. The intent was that the survey would serve a dual purpose. It would be used as a means to reveal some of the CHA data as well as to gather further input that could be used towards determining priorities. Survey Monkey was the tool used to create the survey, collect data, and analyze the responses. The survey was made available electronically and via hard copy. Hard copies were placed at public sites. Several presentations in regards to the dual purpose of the survey were made. The survey link was shared through various websites, Facebook pages, email distribution lists, newsletters, etc. Although survey demographics reflect that there were under-represented populations, the team made concerted efforts to get involvement from both genders, different age groups, and minorities. Survey respondents were primarily white, females in the 40-59 age range. Team members with assistance from Health Department staff were diligent in pursuing participation from adults under the age of 40 and over the age of 60, men, and minorities. Person County Medical Reserve Corps volunteers and Healthy Personians volunteers were instrumental in sharing CHA results and getting members of the public to participate in the survey at a community screening event, which involved many older adults. The Health Department’s Foreign Language Interpreter conducted the survey via interview style with non-English speaking clients. The survey generated more responses from both elected and appointed county officials than it had in the past. There were 335 surveys completed which was more than twice as many as were completed in 2011. During the two and half weeks that the survey was being conducted the CHA team met several times to review existing data. That which was reviewed and discussed at length included:  County mortality and morbidity data and how it compared to a peer county (Bladen County) and the state.  County rates compared to that of itself from the previous assessment for certain areas and any trends.  Data from a community screening event in 2012.  Data from a market research project conducted in 2013.  Community health survey data from earlier in 2014 and how it compared to the survey data from 2011. An adaptation of the “Hanlon Method” referenced in the Community Health Assessment Guide Book was the methodology used by the team to correlate the data. An initial list of health problems was established by the group from which to work. The Problem Importance Worksheet, found in the guide book, was useful in helping the group rate each problem based on the following criteria: 1. Magnitude: How many persons does the problem affect, either actual or potential? 2. Seriousness of Consequences: What degree of disability or premature death occurs because of the problem? What are the potential burdens to the community, such as economic or social burdens? 137 50 3. Feasibility of Correcting: Is the problem amendable to interventions? What technology, knowledge or resources are necessary to effect a change? Is the problem preventable? Other factors taken into consideration by the team when rating problems included:  How do these issues fit in with the Healthy North Carolina 2020 objectives?  What keeps recurring in the primary and secondary data?  What is the county’s capacity to address the issues?  Availability of personnel (professional or volunteer)  Availability of expertise  Commitment of partners  Availability of time  Availability of technology, equipment, or supplies  Availability of funding (direct or in-kind)  Community support PRIORITIES Once the priority setting survey closed the team reviewed the results and factored them into the ratings. The vast majority of this new survey data aligned with the ratings and the same issues continued to surface thus affirming the direction that the team was heading in terms of establishing priorities. After four meetings and conducting this additional survey the following were established as Person County’s health priorities for the next four years (2015-2019):  Chronic Disease: Diabetes  Overweight/Obesity 138 51 REFERENCES 1 Person County 2011 Community Health Assessment, Volume One: Demographic, Socioeconomic and Health Data, Community Survey, Issues Prioritization; October, 2011. 2 US Census Bureau, American Fact Finder, 2010 Census, Summary File DP-1, 2010 Demographic Profile Data, Profile of General Population and Housing Characteristics: 2010; http://factfinder2.census.gov. 3 US Census Bureau, American FactFinder, 2010 Census, Summary File DP-1, 2010 Demographic Profile Data, Profile of General Population and Housing Characteristics: 2010; http://factfinder2.census.gov. 4 US Census Bureau, American FactFinder. 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NC Department of Commerce, Research and Publications, Incentive Reports; http://www.nccommerce.com/research- publications/incentive-reports/county-tier-designations. 11 NC Department of Commerce, AccessNC, Community Demographics, County Report, County Profile, http://accessnc.commerce.state.nc.us/EDIS/page1.html and US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimate. http://factfinder2.census.gov. 12 NC Employment Security Commission, Labor Market Information, Industry Information. Employment and Wages Data by Industry, 2012, Annual Summary. By State or by County. http://eslmi23.esc.state.nc.us/ew/EWYear.asp?Report=1. 13 NC Employment Security Commission, Labor Market Information, Workforce Information, Employed, Unemployed and Unemployment Rates, Labor Force Statistics, Single Areas for All Years; http://eslmi03.esc.state.nc.us/ThematicLAUS/clfasp/startCLFSAAY.asp. 14 US Census Bureau, American Fact Finder, American Community Survey, 2011, 2012 ACS 5-Year Estimates, Table DP03: Selected Economic Characteristics, County, North Carolina (Counties as listed); http://factfinder2.census.gov. 15 US Census Bureau, American Fact Finder, American Community Survey, 2010, 2011 and 2012 American Community Survey 5-Year Estimates, Table S1701: Poverty Status in the Past 12 Months. Data Profiles, County, North Carolina; http://factfinder2.census.gov. 16 US Census Bureau, American Fact Finder, American Community Survey, 2010, 2011 and 2012 American Community Survey 5-Year Estimates, Data Profiles, County, North Carolina; http://factfinder2.census.gov. 139 52 17 US Census Bureau, American FactFinder, American Community Survey, 2009 and 2012 ACS 5-Year Estimates. Table DP04: Selected Housing Characteristics; http://factfinder2.census.gov. 18 US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimates, Table DP04: Selected Housing Characteristics (geographies as listed). http://factfinder2.census.gov. 19 County Profiles: Person and Bladen Counties and North Carolina. NC Rural Economic Development Center website: Rural Data Bank; http://www.ncruralcenter.org/index.php?option=com_wrapper&view=wrapper&Itemid=121. 20 NC Housing Coalition, County Resource Guides; http://www.nchousing.org/need_help/housing_location/county-resource-guides/atct_topic_view?b_start:int=20&-C=. 21 NC Coalition to End Homelessness, NC Point-In-Time County Data, Data by Year, NC Balance of State by County, 2009-2014; http://www.ncceh.org/PITdata/. 22 Piedmont Community College, http://www.piedmontcc.edu/. (Accessed July 7, 2014). 23 NC Department of Public Instruction, Data and Statistics, Education Data, NC School Report Cards, School Year 2012-13; http://www.ncreportcards.org/src. 24 2013 North Carolina Directory of Non-Public Schools; http://www.ncdnpe.org/documents/12- 13-CS-Directory.pdf. 25 NC Department of Public Instruction, Data and Statistics, Education Data: NC Statistical Profile. NC Statistical Profile Online: Local Education Agencies Information, Pupil Accounting. http://apps.schools.nc.gov/pls/apex/f?p=1:1:497147721913602. 26 NC Department of Public Instruction, Research and Evaluation, Dropout Data and Collection Process, Annual Dropout Reports; http://www.ncpublicschools.org/research/dropout/reports/. 27 Public Schools of North Carolina, Cohort Graduation Rate. 4-Year Cohort Graduation Rate Report, 2009-10 Entering 9th Graders Graduating in 2012-13 or Earlier. http://www.ncpublicschools.org/accountability/reporting/cohortgradrate. 28 Personal communication from Natalie Brozy, Managing Executive Director, Roxboro Community School, to Janet Clayton, Health Director, Person County Health Department; July 2, 2014. 29 NC Department of Justice, State Bureau of Investigation, Crime, View Crime Statistics, Crime Statistics (by Year); http://ncdoj.gov/Crime/View-Crime-Statistics.aspx. 30 NC State Bureau of Investigation, Crime in North Carolina, North Carolina Crime Statistics, Crime Statistics in Detailed Reports (By Year), 2011 Annual Reports, County Offenses Ten Year Trend, http://crimereporting.ncdoj.gov/. 31 NC Department of Justice, Sex Offender Statistics, Offender Statistics; http://sexoffender.ncdoj.gov/stats.aspx. 32 NC Department of Crime Control and Public Safety, Governor's Crime Commission, Publications. Gangs in North Carolina 2013: An Analysis of GangNET Data, March 2013, Appendix 2. https://www.ncdps.gov/div/GCC/PDFs/Pubs/Gangs2013.pdf. 33 NC Department of Justice, State Bureau of Investigation, Crime, Enforce Drug Laws, Meth Focus, Meth Lab Busts; http://www.ncdoj.gov/getdoc/b1f6f30e-df89-4679-9889-53a3f185c849/Meth-Lab-Busts.aspx. 34 NC Department of Juvenile Justice and Delinquency Prevention, Statistics and Legislative Reports, County Databooks (Search by Year); https://www.ncdps.gov/index2.cfm?a=000003,002476,002483,002482,002506,002523. 35 NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, County Statistics (years as noted); http://www.doa.state.nc.us/cfw/stats.htm. 140 53 36 NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, County Statistics (years as noted); http://www.doa.state.nc.us/cfw/stats.htm. 37 Child Welfare, Reports of Abuse and Neglect section, Reports of Abuse and Neglect Type of Finding/Decision (Not Exclusive) (Longitudinal Data); http://sasweb.unc.edu/cgi- bin/broker?_service=default&_program=cwweb.tbReport.sas&county=Alamance&label=County&format=html&entry=10&type=CHILD&fn=FRST&vtype=xfind. 38 NC DHHS Division of Aging and Adult Services. Adult Protective Services. APS Survey Data, 2009 and 2011. http://www.ncdhhs.gov/aging/adultsvcs/afs_aps.htm. 39 Person County Department of Social Services Annual Reports, FY2010-11, FY2011-12, and FY2012-13. Personal communication from Carlton B. Paylor, Sr., Director, Person County Department of Social Services, to LeighAnn Creson, Health Educator, Person County Health Department, March 18, 2014. 40 Toxics release inventory (TRI) fact sheet. US Environmental Protection Agency, Toxics Release Inventory (TRI) Program website: http://www.epa.gov/tri/triprogram/TRI_Factsheet_Jan_2012.pdf. 41 TRI Release Reports: Geography State Report, 2013. US EPA TRI Explorer, Release Reports, Chemical Reports website: http://iaspub.epa.gov/triexplorer/tri_release.chemical. 42 TRI Release Reports: Chemical Reports, 2012. Retrieved on August 5, 2014 from US EPA TRI Explorer, Release Reports, Chemical Reports website: http://iaspub.epa.gov/triexplorer/tri_release.chemical. 43 SDWIS. US Environmental Protection Agency Envirofacts website: http://www.epa.gov/enviro/facts/sdwis/search.html. 44 Safe Drinking Water Search for the State of North Carolina. Retrieved on April 9, 2014 from US EPA Envirofacts Safe Drinking Water Information System (SDWIS) website: http://www.epa.gov/enviro/facts/sdwis/search.html. 45 NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Program, NC Solid Waste Management Annual Reports, County Per Capita Report, Fiscal Year 2012-2013; http://portal.ncdenr.org/c/document_library/get_file?p_l_id=4649434&folderId=15429422&name=DLFE-80542.pdf. 46 NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Section. Solid Waste Management Annual Reports, FY2012-2013; County Waste Disposal Report Fiscal Year 2012-2013. http://portal.ncdenr.org/web/wm/sw/swmar. 47 NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Section. Solid Waste Management Annual Reports, FY2012-13; Landfill Capacity Report Fiscal Year 2012-2013. http://portal.ncdenr.org/c/document_library/get_file?p_l_id=4649434&folderId=15429422&name=DLFE-80550.pdf. 48 Person County and the City of Roxboro 10 Year Solid Waste Management Plan, July 1, 2012-June 30, 2022. Available at http://www.personcounty.net/Modules/ShowDocument.aspx?documentid=1963. 49 NC Center for Health Statistics, County-level Data, County Health Data Books (2010-2014). Pregnancy and Live Births. Pregnancy, Fertility, & Abortion Rates per 1,000 Population, by Race, by Age; http://www.schs.state.nc.us/SCHS/data/databook/. 50 NC State Center for Health Statistics, North Carolina Health Data Query System. Pregnancy Data. North Carolina Reported Pregnancy Data (2004-2012); http://www.schs.state.nc.us/schs/data/preg/preg.cfm. 51 NC State Center for Health Statistics, County-level Data, County Health Data Book (2013), Pregnancy and Births, 2007-2011 Number At Risk NC Live Births due to High Parity by County of Residence; http://www.schs.state.nc.us/SCHS/data/databook/. 141 54 52 NC State Center for Health Statistics, County-level Data, County Health Data Book (2013), Pregnancy and Births, 2007-2011 NC Live Births by County of Residence, Number with Interval from Last Delivery to Conception of Six Months or Less; http://www.schs.state.nc.us/SCHS/data/databook/. 53 NC State Center for Health Statistics, Basic Automated Birth Yearbook (BABY Book), North Carolina Residents (2006, 2007,-2008, 2009, 2010, 2011 and 2012) (geographies as noted): Table 6 (and others): County Resident Births by Month Prenatal Care Began, All Women; http://www.schs.state.nc.us/schs/births/babybook/. 54 NC State Center for Health Statistics, Vital Statistics, Volume 1 (2006, 2007,-2008, 2009, 2010, 2011 and 2012): Population, Births, Deaths, Marriages, Divorces, Mother Smoked; http://www.schs.state.nc.us/schs/data/vitalstats.cfm. 55 Low birthweight. March of Dimes, Pregnancy, Your Premature Baby; http://www.marchofdimes.com/baby/premature_lowbirthweight.html. 56 NC State Center for Health Statistics, County-level Data, County Health Data Books (2012, 2013, 2014), Pregnancy and Births, Low and Very Low Weight Births; http://www.schs.state.nc.us/SCHS/data/databook/. 57 NC Center for Health Statistics, County-level Data, County Health Data Books (2008-2014), Mortality, Infant Death Rates per 1,000 Live Births; http://www.schs.state.nc.us/SCHS/data/databook/. 58 NC Center for Health Statistics, County-level Data, County Health Data Books (2012-2014), Mortality, Infant Death Rates per 1,000 Live Births; http://www.schs.state.nc.us/SCHS/data/databook/. 59 NC State Center for Health Statistics, County Health Data Book (2014), Mortality, Death Counts and Crude Death Rates per 100,000 for Leading Causes of Death, by Age Groups, NC, 2008-2012; http://www.schs.state.nc.us/SCHS/data/databook/. 60 2014 Person County Community Health Assessment, Secondary Data and Community Health Survey Report, Chapter Six: Community Health Survey. 61 NC State Center for Health Statistics, County-level Data, County Health Data Books (2008- 2014), Morbidity, Inpatient Hospital Utilization and Charges by Principal Diagnosis and County of Residence; http://www.schs.state.nc.us/SCHS/data/databook/. 62 NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. 63 Centers for Disease Control and Prevention, Diabetes Data and Trends, County Level Estimates of Diagnosed Diabetes - of Adults in North Carolina, 2006-2011; http://apps.nccd.cdc.gov/ddtstrs/default.aspx. 64 Centers for Disease Control and Prevention, Obesity Data and Trends, County Level Estimates of Diagnosed Obesity - of Adults in North Carolina, 2006-2011; http://apps.nccd.cdc.gov/ddtstrs/default.aspx. 65 Personal communication, LeighAnn Creson, Health Educator, Person County Health Department, to Sheila Pfaender, Public Health Consultant, July 3, 2014. 66 Person County: Everything is Better in Person. Person County Consumer Research, 2013 Marshall Marketing Report. Marshall Marketing Research, Analysis and Consulting. 67 Eat Smart, Move More, Data on Children and Youth in NC, North Carolina Nutrition and Physical Activity Surveillance System (NC-NPASS), NC-NPASS Data (2007-2012); http://www.eatsmartmovemorenc.com/Data/ChildAndYouthData.html. 68 NC DHHS, Division of Public Health, Epidemiology Section, Communicable Disease Branch. Facts and Figures, Annual Reports. North Carolina 2012 HIV/STD Surveillance Report, Table 8; http://epi.publichealth.nc.gov/cd/stds/figures/std12rpt.pdf. 142 55 69 Gonorrhea. Centers for Disease Control and Prevention, CDC A-Z Index website; http://www.cdc.gov/std/Gonorrhea/. 70 Personal communication, LeighAnn Creson, Health Educator, Person County Health Department, to Sheila Pfaender, Public Health Consultant, January 16, 2015. 71 Cecil G. Sheps Center for Health Services Research, North Carolina Health Professions Data System, North Carolina Health Professions Data Books, Table 14 (2008, 2009, 2010, 2011); http://www.shepscenter.unc.edu/hp/publications.htm. 72 Cecil G. Sheps Center for Health Services Research, North Carolina Health Professions Data System. Publications. 2011 North Carolina Health Professions Databook; http://www.shepscenter.unc.edu/hp/publications/2011_HPDS_DataBook.pdf. 73 NC Division of Medical Assistance, Medicaid, Find a Doctor, NC Medicaid and NC Health Choice Dental Provider Lists; http://www.ncdhhs.gov/dma/dental/dentalprov.htm. 74 Person Memorial Hospital; http://www.personhospital.com/. 75 Person County Health Department brochure 76 US Health Resources and Services Administration website: Find a Health Center (Search by State or County). http://findahealthcenter.hrsa.gov/Search_HCC.aspx?byCounty=1. 77 Person Family Medical and Dental Center, Inc., www.personfamilymedical.com/. 78 Personal communication, LeighAnn Creson, Health Educator, Person County Health Department, to Sheila Pfaender, Public Health Consultant, July 2, 2014. 79 NC Annual School Health Services Report, 2011-2012. http://www.ncdhhs.gov/dph/wch/doc/stats/SchoolHealthServicesAnnualReport2011- 2012.pdf. 80 NC Department of Health and Human Services, Division of Health Services Regulation (DHSR), Licensed Facilities, Adult Care Homes, Family Care Homes, Nursing Facilities (by County); http://www.ncdhhs.gov/dhsr/reports.htm. 81 NC Department of Health and Human Services, Division of Health Services Regulation (DHSR), Licensed Facilities, Home Care Only, Home Care with Hospice, Home Health Only, and Home Health with Hospice Facilities (by County); http://www.ncdhhs.gov/dhsr/reports.htm. 82 Person County Department of Social Services Annual Reports, FY2010-11, FY2011-12, and FY2012-13. Personal communication from Carlton B. Paylor, Sr., Director, Person County Department of Social Services, to LeighAnn Creson, Health Educator, Person County Health Department, March 18, 2014. 83 Local Contacts: Local Management Entities by Name. NC Department of Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services website; http://www.ncdhhs.gov/mhddsas/lmeonbluebyname.htm. 84 Cardinal Innovations Healthcare Solutions, 2014 Demographic, Utilization and Network Capacity Study, January 14, 2014. Available at: http://www.cardinalhealthcareinnovations.org/providers/resources/analysis-and-reports. 85 NC Department of Health and Human Services, Division of Health Services Regulation (DHSR), Licensed Facilities, Mental Health Facilities (G.S. 122C) (by County); http://www.ncdhhs.gov/dhsr/reports.htm. 86 NC Department of Health and Human Services, Division of Health Services Regulation (DHSR), Licensed Facilities; http://www.ncdhhs.gov/dhsr/reports.htm. 87 Dialysis Facility Compare, http://www.Medicare.gov/Dialysis/Include/DataSection/Questions. 88 Parks and Recreation. Person County website; http://www.personcounty.net/index.aspx?page=181. 143 56 APPENDICES APPENDIX 1: DATA WORKBOOK APPENDIX 2: 2014 PERSON COUNTY COMMUNITY HEALTH SURVEY APPENDIX 3: CONSULTANT’S SUMMARY PRESENTATION APPENDIX 4: 2012 HEALTHY LIVING FOR A LIFETIME REPORT APPENDIX 5: 2013 MARSHALL MARKETING REPORT 144 APPENDIX 1 1 DATA WORKBOOK Demographic Data Population General Demographic Characteristics (2010 US Census) Note: percentages by gender are calculated. Source: US Census Bureau, American Fact Finder, 2010 Census, Summary File DP-1, 2010 Demographic Profile Data, Profile of General Population and Housing Characteristics: 2010; http://factfinder2.census.gov. Population Distribution by Age and Gender, Number and Percent (2010 US Census) US Census Bureau, American FactFinder, 2010 Census, 2010 Demographic Profile Data, Summary File DP-1, Profile of General Population and Housing Characteristics: 2010 (Geographies as noted); http://factfinder2.census.gov. Person County 39,464 19,137 48.5 40.1 20,327 51.5 42.8 41.4 Bladen County 35,190 16,887 48.0 39.7 18,303 52.0 42.8 41.3 State of NC 9,535,483 4,645,492 48.7 36.0 4,889,991 51.3 38.7 37.4 Median Age Males Median Age Females % Population Female Overall Median Age Location % Population Male Total Population Number Males Number Females Total Male Female Total Male Female Total Male Female Total Male Female All ages 39,464 19,137 20,327 100.0 48.5 51.5 9,535,483 4,645,492 4,889,991 100.0 48.7 51.3 Under 5 2369 1186 1183 6.0 3.0 3.0 632,040 322,871 309,169 6.6 3.4 3.2 5 to 9 2504 1329 1175 6.3 3.4 3.0 635,945 324,900 311,045 6.7 3.4 3.3 10 to 14 2603 1312 1291 6.6 3.3 3.3 631,104 322,795 308,309 6.6 3.4 3.2 15 to 19 2628 1354 1274 6.7 3.4 3.2 659,591 338,271 321,320 6.9 3.5 3.4 20 to 24 1971 1018 953 5.0 2.9 2.4 661,573 336,648 324,925 6.9 3.5 3.4 25 to 29 2036 993 1043 5.2 2.5 2.6 627,036 311,499 315,537 6.6 3.3 3.3 30 to 34 2204 1073 1131 5.6 2.7 2.9 619,557 304,807 314,750 6.5 3.2 3.3 35 to 39 2623 1282 1341 6.6 3.2 3.4 659,843 324,681 335,162 6.9 3.4 3.5 40 to 44 2672 1306 1366 6.8 3.3 3.5 667,308 329,652 337,656 7.0 3.5 3.5 45 to 49 3137 1552 1585 7.9 3.9 4.0 698,753 341,432 357,321 7.3 3.6 3.7 50 to 54 3307 1634 1673 8.4 4.1 4.2 669,893 323,702 346,191 7.0 3.4 3.6 55 to 59 2811 1325 1486 7.1 3.4 3.8 600,722 285,244 315,478 6.3 3.0 3.3 60 to 64 2606 1244 1362 6.6 3.2 3.5 538,039 255,034 283,005 5.6 2.7 3.0 65 to 69 1914 906 1011 4.8 2.3 2.6 403,024 188,125 214,899 4.2 2.0 2.3 70 to 74 1471 667 804 3.7 1.7 2.0 294,543 133,021 161,522 3.1 1.4 1.7 75 to 79 1115 452 663 2.8 1.1 1.7 223,655 94,981 128,674 2.3 1.0 1.3 80 to 84 761 291 470 1.9 0.7 1.2 165,396 63,573 101,823 1.7 0.7 1.1 85 and older 732 216 516 1.9 0.5 1.3 147,461 44,256 103,205 1.5 0.5 1.1 Age Group Person County North Carolina % of Total Population No. in Population % of Total PopulationNo. in Population 145 APPENDIX 1 2 Growth Trend for Elderly (Age 65 and Older) Population, by Decade, 2000 through 2030 1 - US Census Bureau, American FactFinder. Profile of General Demographic Characteristics: 2000 (DP-1), SF1; http://factfinder2.census.gov. 2 - US Census Bureau, American FactFinder. Profile of General Population and Housing Characteristics: 2010 (DP-1); http://factfinder2.census.gov. 3 - NC Office of State Budget and Management, County/State Population Projections. Age, Race, and Sex Projections, Age Groups - Total, July 1, 2020 County Total Age Groups - Standard; http://www.osbm.state.nc.us/ncosbm/facts_and_figures/socioeconomic_data/population_estimates/county_projections.shtm. 4 - NC Office of State Budget and Management, County/State Population Projections. Age, Race, and Sex Projections, Age Groups - Total, July 1, 2030 County Total Age Groups - Standard; http://www.osbm.state.nc.us/ncosbm/facts_and_figures/socioeconomic_data/population_estimates/county_projections.shtm. 5 - Percentages calculated using age group population as numerator and total population as denominator Total Population (2000) # Population Age 65 and Older % Population Age 65 and Older # Age 65-74 % Age 65- 74 # Age 75-84 % Age 75- 84 # Age 85+ % Age 85+ Person County 35,623 4,890 13.7 2,676 7.5 1,700 4.8 514 1.4 Bladen County 32,278 4,598 14.2 2,571 8.0 1,550 4.8 477 1.5 State of NC 8,049,313 969,048 12.0 533,777 6.6 329,810 4.1 105,461 1.3 Source 1 1 1 1 5 1 5 1 5 Location 2000 Census Total Population (2010) # Population Age 65 and Older % Population Age 65 and Older # Age 65-74 % Age 65- 74 # Age 75-84 % Age 75- 84 # Age 85+ % Age 85+ Person County 39,464 5,993 15.2 3,385 8.5 1,876 4.7 732 1.9 Bladen County 35,190 5,481 15.6 3,260 9.2 1,692 4.8 529 1.5 State of NC 9,535,483 1,234,079 12.9 697,567 7.3 389,051 4.1 147,461 1.5 Source 2 2 2 2 5 2 5 2 5 2010 Census Location Total Projected Population # Population Age 65 and Older % Population Age 65 and Older # Age 65-74 % Age 65- 74 # Age 75-84 % Age 75- 84 # Age 85+ % Age 85+ Person County 39,669 7,919 20.0 4,740 11.9 2,375 6.0 804 2.0 Bladen County 35,313 7,594 21.5 4,562 12.9 2,304 6.5 728 2.1 State of NC 10,614,862 1,763,950 16.6 1,051,688 9.9 519,963 4.9 192,299 1.8 Source 3 3 5 3 5 3 5 3 5 Location 2020 (Projected) Total Projected Population # Population Age 65 and Older % Population Age 65 and Older # Age 65-74 % Age 65- 74 # Age 75-84 % Age 75- 84 # Age 85+ % Age 85+ Person County 40,271 9,719 24.1 5,320 13.2 3,369 8.4 1,030 2.6 Bladen County 35,473 8,756 24.7 4,543 12.8 3,216 9.1 997 2.8 State of NC 11,629,556 2,262,855 19.5 1,241,404 10.7 765,598 6.6 255,853 2.2 Source 4 4 5 4 5 4 5 4 5 Location 2030 (Projected) 146 APPENDIX 1 3 Home Care Assistance Services Provided by Person County DSS (FY2010-11 through FY2012-13) Source: Person County Department of Social Services Annual Reports, FY2010-11, FY2011-12, and FY2012-13. Personal communication from Carlton B. Paylor, Sr., Director, Person County Department of Social Services, to LeighAnn Creson, Health Educator, Person County Health Department, March 18, 2014. Economic and Sociodemographic Data Income Measures Source (except as noted): NC Department of Commerce, AccessNC, Community Demographics, County Report, County Profile, http://accessnc.commerce.state.nc.us/EDIS/page1.html. 1 US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimate. http://factfinder2.census.gov. Community Alternatives Persons receiving services 54 50 48 Average monthly Medicaid cost per case $2,560 $2,478 $2,648 Visits made by contract nurse 648 612 522 Program screenings 50 50 50 Home Management Services Home visits made 225 124 346 Families served 167 126 174 General transportation services provided 442 440 772 Special Assistance - In-Home Persons screened for services 3 2 2 Persons approved for services 3 2 7 Persons served during year 8 8 7 Average per-person monthly cost $449 $399 $439 Average per-person monthly cost for rest home care $1,182 $1,182 $1,182 Special Assistance - Rest Home Recipients in rest homes 197 196 200 Adult Care Home Case Management Persons receiving services 38 36 31 Homes serving this population 5 6 10 In-Home Aide Services Individuals served 12 8 9 Average monthly number of clients served 11 7 6 Additional requests for services received 13 17 11 Additional requests eligible for services and referred to outside agencies 13 12 10 Monitoring visits made by agency social workers 68 40 36 Average per-client monthly cost of in-home aide services $636 $526 $719 Adult Day Care Client supervisory/monitoring visits made 75 52 43 Clients served 8 7 7 Service/Activity FY2010-11 FY2011-12 FY2012-13 Person County $20,493 -$3,462 $39,828 -$4,088 $52,490 -$430 Bladen County $17,275 -$6,680 $28,992 -$14,924 $42,099 -$10,821 State of NC $23,955 n/a $43,916 1 n/a $52,920 1 n/a 2011 Est Median Family Income Median Family Income Difference from State Location 2012 Projected Per Capita Personal Income Per Capita Income Difference from State 2012 Projected Median Household Income Median Household Income Difference from State 147 APPENDIX 1 4 Annual Unemployment Rate (2000-2012) Note: 2012 figures represent the average monthly rate from January through September. Source: NC Employment Security Commission, Labor Market Information, Workforce Information, Employed, Unemployed and Unemployment Rates, Labor Force Statistics, Single Areas for All Years; http://eslmi03.esc.state.nc.us/ThematicLAUS/clfasp/startCLFSAAY.asp. Annual Poverty Rate, 100% Level (1970-2000; 2006-2010, 2007-2011 and 2008-2012 Five-Year Estimates) a - Log Into North Carolina (LINC) Database, Topic Group Employment and Income (Data Item 6094); http://data.osbm.state.nc.us/pls/linc/dyn_linc_main.show. b - US Census Bureau, American Fact Finder, American Community Survey, 2010 ACS 5-Year Estimates, Data Profiles, County, North Carolina (Counties as listed); http://factfinder2.census.gov. c - US Census Bureau, American Fact Finder, American Community Survey, 2011 ACS 5-Year Estimates, Data Profiles, County, North Carolina (Counties as listed); http://factfinder2.census.gov. d - US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimates, Table DP03: Selected Economic Characteristics, County, North Carolina (Counties as listed); http://factfinder2.census.gov. Persons in Poverty by Race, 100% Level (2000 Count; 2006-2010, 2007-2011 and 2008-2012 Five-Year Estimates) Source - US Census Bureau, American Fact Finder, American Community Survey, 2010, 2011 and 2012 ACS 5-Year Estimates, Table S1701: Poverty Status in the Past 12 Months. Data Profiles, County, North Carolina (Counties as listed); http://factfinder2.census.gov. 1970 1980 1990 2000 2006-2010 2007-2011 2008-2012 Person County 25.2 16.6 13.0 20.2 16.0 18.1 16.4 Bladen County 36.5 24.6 21.9 21.0 24.1 23.6 24.4 State of NC 20.3 14.8 13.0 12.3 15.5 16.1 16.8 Source:a a a a b c d Location Percent of All People in Poverty Person County 16.0 13.9 22.0 18.1 13.4 30.6 16.4 11.5 28.8 Bladen County 24.1 13.8 38.2 23.6 13.4 36.6 24.4 15.9 35.4 State of NC 15.5 11.2 25.6 16.1 11.8 26.1 16.8 12.5 26.8 2008-2012 Total % in Poverty % White in Poverty % Black in Poverty Total % in Poverty % White in Poverty % Black in Poverty Location 2007-2011 Total % in Poverty % White in Poverty % Black in Poverty 2006-2010 148 APPENDIX 1 5 Persons in Poverty by Age, 100% Level (2006-2010, 2007-11 and 2008-2012 Five-Year Estimates) Source - US Census Bureau, American Fact Finder, American Community Survey, 2010, 2011 and 2012 ACS 5-Year Estimates, Table S1701: Poverty Status in the Past 12 Months. Data Profiles, County, North Carolina (Counties as listed); http://factfinder2.census.gov. Estimated Housing Cost as Percent of Household Income (2005-09 and 2008-2012 Five-Year Estimates) 1 - US Census Bureau, American FactFinder, American Community Survey, 2009 ACS 5-Year Estimates. Table DP04: Selected Housing Characteristics (geographies as listed). http://factfinder2.census.gov. 2 - US Census Bureau, American FactFinder, American Community Survey, 2012 ACS 5-Year Estimates. Table DP04: Selected Housing Characteristics (geographies as listed). http://factfinder2.census.gov. 3 – Percentages are calculated. Housing by Type (2008-2012 Five-Year Estimate) Source - US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimates, Table DP04: Selected Housing Characteristics (geographies as listed). http://factfinder2.census.gov. K-12 Public School Enrollment (SY2006-07 through SY2012-13) Source: NC Department of Public Instruction, Data and Statistics, Education Data: NC Statistical Profile. NC Statistical Profile Online: Local Education Agencies Information, Pupil Accounting. http://apps.schools.nc.gov/pls/apex/f?p=1:1:497147721913602. Person County 16.0 33.7 24.7 15.4 18.1 35.5 26.2 14.5 16.4 26.8 19.9 12.3 Bladen County 24.1 37.2 32.8 20.8 23.6 40.8 34.6 17.9 24.4 41.7 34.8 18.0 State of NC 15.5 25.5 21.3 10.7 16.1 26.4 22.3 10.3 16.8 28.0 23.5 10.2 2008-2012 Total % in Poverty % Related Children Under 5 in Poverty % Related Children Under 18 in Poverty % Adults 65 or Older in Poverty Total % in Poverty % Related Children Under 18 in Poverty % Adults 65 or Older in Poverty Location % Related Children Under 5 in Poverty 2006-2010 2007-2011 % Related Children Under 18 in Poverty % Adults 65 or Older in Poverty % Related Children Under 5 in Poverty Total % in Poverty # %# %# %# % Person County 2,926 1,530 52.3 3,483 1,620 46.5 4,202 1,618 38.5 7,142 2,359 33.0 Bladen County 3,460 1,419 41.0 3,298 1,731 52.5 6,992 1,961 28.0 4472 1,721 38.5 State of NC 1,131,480 486,934 43.0 1,095,577 554,428 50.6 1,634,410 513,340 31.4 1,658,483 539,993 32.6 Source 1 1 3 2 2 3 1 1 3 2 2 3 Total Units Units Spending >30% Household Income on Housing Location Renter Occupied Units Mortgaged Housing Units 2005-2009 2008-2012 2005-2009 2008-2012 Total Units Units Spending >30% Household Income on Housing Total Units Units Spending >30% Household Income on Housing Total Units Units Spending >30% Household Income on Housing No. No. % No. % No. %$No. % $ No. % Person County 18,138 2,762 15.2 15,376 84.8 11,216 72.9 $1,127 4,160 27.1 $649 4,330 23.9 Bladen County 17,616 3,534 20.1 14,082 79.9 9,597 68.2 $981 4,485 31.8 $593 6,398 36.3 State of NC 4,325,088 631,867 14.6 3,693,221 85.5 2,477,360 67.1 $1,287 1,215,861 32.9 $759 599,924 13.9 Location 2008-2012 Estimate Total Housing Units Vacant Housing Units Occupied Housing Units Owner Occupied Units Median Monthly Housing Cost, Homes With Mortgage Renter Occupied Units Median Gross Monthly Rent Mobile Home Units SY2006-07 SY2007-08 SY2008-09 SY2009-10 SY2010-11 SY2011-12 SY2012-13 Person County Schools 5,812 5,713 5,375 5,183 5,094 4,936 4,819 Roxboro Community School 220 291 433 529 587 617 654 Bethel Hill Charter School 369 370 370 375 375 382 378 Bladen County Schools 5,697 5,573 5,342 5,362 5,389 5,323 5,189 State of NC 1,452,420 1,458,156 1,456,558 1,446,650 1,450,435 1,458,572 1,467,297 Location Number of Students 149 APPENDIX 1 6 Educational Attainment a - US Census Bureau, American Fact Finder, American Community Survey, 2012 ACS 5-Year Estimates, Data Profiles, Detailed Tables, Selected Social Characteristics, Educational Attainment, by State or County; http://factfinder.census.gov. b - NC Department of Public Instruction, Data and Statistics, Education Data, NC School Report Cards. District Profile; Charter School Profiles; http://www.ncreportcards.org/src/. High School Drop-Out Rate (SY2005-06 through SY2012-13) Source: NC Department of Public Instruction, Research and Evaluation, Dropout Data and Collection Process, Annual Dropout Reports; http://www.ncpublicschools.org/research/dropout/reports/. Four Year Cohort Graduation Rate (9th Graders Entering SY2009-10 and Graduating SY2012-13 or Earlier) Note: subgroup information is based on data collected when a student is last seen in the cohort Source: Public Schools of North Carolina, Cohort Graduation Rate. 4-Year Cohort Graduation Rate Report, 2009-10 Entering 9th Graders Graduating in 2012-13 or Earlier. http://www.ncpublicschools.org/accountability/reporting/cohortgradrate. Crime Rates, Crimes per 100,000 Population (2008-2012) Source: NC Department of Justice, State Bureau of Investigation, Crime, View Crime Statistics, Crime Statistics (by Year); http://ncdoj.gov/Crime/View-Crime-Statistics.aspx. 2008-2012 2008-2012 SY2012-13 SY2012-13 SY2012-13 SY2012-13 SY2012-13 SY2012-13 Person County 82.1 14.5 40.2 44.8 32.6 27.0 52% 963 Roxboro Community School n/a n/a n/a n/a 56.8 42.1 52% 1039 Bethel Hill Charter School n/a n/a 62.9 50.0 n/a n/a n/a n/a Bladen County 74.8 11.1 31.8 29.8 25.2 11.3 44% 865 State of NC 84.5 26.8 45.2 46.8 41.0 34.2 68% 1001 Source:a a b b b b b b % 8th Graders At or Above Grade Level, ABCs EOG Reading Test % 8th Graders At or Above Grade Level, ABCs EOG Math Test % 3rd Graders At or Above Grade Level, ABCs EOG Reading Test % 3rd Graders At or Above Grade Level, ABCs EOG Math Test SAT Participation RateLocation Average Total SAT Scores % Population High School Graduate or Higher % Population Bachelor's Degree or Higher Person County LEA 387 300 77.5 194 148 76.3 193 154 78.8 171 123 71.9 Bladen County Schools 389 307 78.9 194 142 73.2 195 165 84.6 238 192 80.7 State of NC 109,795 90,549 82.5 56,329 44,254 78.6 53,466 46,295 86.6 47,663 36,288 76.1 School System All Students Male Female Economically Disadvantaged Total Students # Students Graduating % Students Graduating Total Students # Students Graduating % Students Graduating Total Students # Students Graduating % Students Graduating Total Students # Students Graduating % Students Graduating 150 APPENDIX 1 7 Types of Crimes Reported in Person County (2008-2012) Source: NC State Bureau of Investigation, Crime in North Carolina, North Carolina Crime Statistics, Crime Statistics in Detailed Reports (By Year), 2011 Annual Reports, County Offenses Ten Year Trend, http://crimereporting.ncdoj.gov/. Other Criminal Activity a - NC Department of Justice, Sex Offender Statistics, Offender Statistics; http://sexoffender.ncdoj.gov/stats.aspx. b - NC Department of Crime Control and Public Safety, Governor's Crime Commission, Publications. Gangs in North Carolina 2013: An Analysis of GangNET Data, March 2013, Appendix 2. https://www.ncdps.gov/div/GCC/PDFs/Pubs/Gangs2013.pdf. c - NC Department of Justice, State Bureau of Investigation, Crime, Enforce Drug Laws, Meth Focus, Meth Lab Busts; http://www.ncdoj.gov/getdoc/b1f6f30e-df89-4679-9889-53a3f185c849/Meth-Lab-Busts.aspx. Juvenile Justice Complaints (2010 through 2012) Source: NC Department of Juvenile Justice and Delinquency Prevention, Statistics and Legislative Reports, County Databooks (Search by Year); https://www.ncdps.gov/index2.cfm?a=000003,002476,002483,002482,002506,002523. Sexual Assault Complaint Trend (FY2004-05 through FY2011-12) “n/a” Program submitted no data. Source: NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, County Statistics (years as noted); http://www.doa.state.nc.us/cfw/stats.htm. 2008 2009 2010 2011 2012 Violent Crime Murder 1 3 4 1 0Rape8 9 14 11 14 Robbery 22 18 16 24 15 Aggravated Assault 120 118 94 94 79 Property Crime Burglary 419 476 466 479 375 Larceny 757 627 709 781 587 Motor VehicleTheft 68 39 45 44 33 Total Index Crimes 1,395 1,290 1,348 1,374 1,103 Type of Crime Number of Crimes 2013 2005 2006 2007 2008 2009 2010 2011 2012 2013 Person County 73 2 0 0 0 0 0 0 0 0 0 Bladen County 65 4 0 0 1 0 0 0 2 0 1 State of NC 14,028 982 328 197 157 197 206 235 344 460 561 Source:a b c c c c c c c c c No. Gangs Location No. Registered Sex Offenders (2/13/14) No. Methamphetamine Lab Busts 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 Person County 64 55 39 148 158 190 11.1 8.8 6.3 31.1 30.6 37.0 Bladen County 13 15 2 68 72 51 2.5 2.7 0.4 15.8 15.9 11.3 State of NC 4,285 3,603 3,194 33,299 33,556 31,575 2.9 2.3 2.5 27.6 26.1 24.7 Location No. Undisciplined No. Delinquent Rate Undisciplined (Complaints per 1,000 Ages 6 to 17) Rate Delinquent (Complaints per 1,000 Age 6 to 15) Complaints 151 APPENDIX 1 8 Domestic Violence Complaint Trend (FY2004-05 through FY2011-12) Source: NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, County Statistics (years as noted); http://www.doa.state.nc.us/cfw/stats.htm. Reports of Child Abuse and Neglect, Person County (FY2004-05 through FY2012-13) Source: Child Welfare, Reports of Abuse and Neglect section, Reports of Abuse and Neglect Type of Finding/Decision (Not Exclusive) (Longitudinal Data); http://sasweb.unc.edu/cgi-bin/broker?_service=default&_program=cwweb.tbReport.sas&county=Alamance&label=County&format=html&entry=10&type=CHILD&fn=FRST&vtype=xfind. Adult Protective Services Survey Results (2009, 2011) Source: NC DHHS Division of Aging and Adult Services. Adult Protective Services. APS Survey Data, 2009 and 2011. http://www.ncdhhs.gov/aging/adultsvcs/afs_aps.htm. Adult Protective Services Activity Summary, Person County DSS (FY2010-11 through FY2012-13) Source: Person County Department of Social Services Annual Reports, FY2010-11, FY2011-12, and FY2012-13. Personal communication from Carlton B. Paylor, Sr., Director, Person County Department of Social Services, to LeighAnn Creson, Health Educator, Person County Health Department, March 18, 2014. FY2004-05 FY2005-06 FY2006-07 FY2007-08 FY2008-09 FY2009-10 FY2010-11 FY2011-12 Person County 166 219 137 122 141 91 181 178 Bladen County 209 118 130 316 269 335 340 442 State of NC 50,726 48,173 47,305 41,787 51,873 66,320 61,283 51,563 Location No. of Individuals Filing Complaints ("Clients") Category 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 Total No. of Findings of Abuse, Neglect, Dependency 279 352 303 275 235 237 239 151 158 No. Substantiated1 Findings of Abuse and Neglect 1 1 1 0 0 7 5 1 2 No. Substantiated Findings of Abuse 5 10 8 4 5 3 0 2 1 No. Substantiated Findings of Neglect 40 28 23 26 11 28 40 33 26 Services Recommended 0 2 2 11 6 6 6 6 5 No. Unsubstantiated Findings 190 221 147 110 90 55 81 57 69 Services Not Recommended 37 87 97 109 98 108 77 25 37 Reports Received Screened In Screened Out Information & Referral Outreach Law Enforcement DHSR/Home Specialist District Attorney VA Div. Medical Assistance Social Security No. Staff Perf. APS Tasks Person County 72 52 20 0 13 2 1 1 0 0 0 4 Bladen County 78 38 40 7 15 1 4 2 0 0 1 5 State of NC 17,073 9,835 7,239 2,443 2,640 471 568 488 34 42 134 542 Location 2009 Reports Received Screened In Screened Out Information & Referral Outreach Law Enforcement DHSR/Home Specialist District Attorney VA Div. Medical Assistance Social Security No. Staff Perf. APS Tasks Person County 125 72 53 1 35 1 4 0 0 0 0 5 Bladen County 68 33 35 9 20 4 2 4 n/a n/a n/a 4 State of NC 19,635 10,929 8,706 2,665 2,736 725 475 651 33 30 152 559 Location 2011 Protective Services for Adults Reports received 125 113 112 Reports meeting legal standards for investigation 72 74 70 Cases where service needs were identified 37 32 32 Cases where adult had to be removed from living situation 3 5 5 Guardianship Legal guardianships established 15 26 34 Individuals assisted in non-agency guardianships 17 13 1 Foster Care for Adults Individuals assisted with out-of-home placements 23 8 7 Average monthly cost of placement, per client $3,118 $3,727 n/a Service/Activity FY2010-11 FY2011-12 FY2012-13 152 APPENDIX 1 9 Environmental Data Toxic Release Inventory (TRI) Summary, Person County (2012) Source: TRI Release Reports: Chemical Reports, 2012. Retrieved on August 5, 2014 from US EPA TRI Explorer, Release Reports, Chemical Reports website: http://iaspub.epa.gov/triexplorer/tri_release.chemical. Population Served by Active Water Systems (2014) 1 - Profile of General Population and Housing Characteristics: 2010 (DP-1). U.S. Census Bureau, American FactFinder website: http://factfinder2.census.gov. 2 - Safe Drinking Water Search for the State of North Carolina. Retrieved on April 9, 2014 from US EPA Envirofacts Safe Drinking Water Information System (SDWIS) website: http://www.epa.gov/enviro/facts/sdwis/search.html. 3 - Calculated from table data Person County 3,665,440 4 Barium compounds 1,032,397 Carolina Power and Light - Roxboro Steam Electric Plant (826,812) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (205,585)Total on-/off-site disposal and other releases Roxboro Sulfuric acid 600,000 Carolina Power and Light - Roxboro Steam Plant (340,000)Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (260,000) Total on-/off-site disposal and other releases Roxboro Vanadium compounds 394,806 Carolina Power and Light - Roxboro Steam Plant (315,652) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (79,154)Total on-/off-site disposal and other releases Roxboro Manganese compounds 280,377 Carolina Power and Light - Roxboro Steam Plant (228,716) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (51,661) Total on-/off-site disposal and other releases Roxboro Zinc compounds 236,146 Carolina Power and Light - Roxboro Steam Plant (187,962)Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (48,184) Total on-/off-site disposal and other releases Roxboro Copper compounds 211,637 Carolina Power and Light - Roxboro Steam Plant (170,476) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (41,161)Total on-/off-site disposal and other releases Roxboro Nickel compounds 185,690 Carolina Power and Light - Roxboro Steam Plant (147,958) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (37,732) Total on-/off-site disposal and other releases Roxboro Chromium compounds 182,497 Carolina Power and Light - Roxboro Steam Plant (145,435)Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (37,062) Total on-/off-site disposal and other releases Roxboro Arsenic compounds 109,274 Carolina Power and Light - Roxboro Steam Plant (87,960) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (21,314)Total on-/off-site disposal and other releases Roxboro Hydrochloric acid 106,367 CPI USA North Carolina LLC (92,967)Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Roxboro Steam Plant (8,900) Total on-/off-site disposal and other releases Roxboro Carolina Power and Light - Mayo Electric Generating Plant (4,500)Total on-/off-site disposal and other releases Roxboro NC Total 54,281,608 NC County Average 542,816 Quantity Released, In Pounds Primary Nature of ReleaseFacilities Releasing Greatest Amount of Compound (Amount, In Pounds) Facility LocationLocationTotal On- and Off-Site Disposal or Other Releases, In Pounds County Rank (of 86 reporting) for Total Releases Compounds Released in Greatest Quantity Person County 39,464 4 12,587 31.9 4 1,289 3.3 46 3,550 17,426 Bladen County 35,190 10 24,329 69.1 4 11,760 33.4 18 1,495 37,584 State of NC 9,535,483 n/a n/a n/a n/a n/a n/a n/a n/a n/a Source 1 2 2 3 2 2 3 2 2 3 Total Population Served by N-T/N-C WSs % Population Served by N-T/N-C WSs Number N-T/N-C WSs Total Population Served by CWSs % Population Served by CWSs Location 2010 Population Number CWSs Number T/N-C WSs Total Population Served by T/N-C WSs Total Population Served by Active Water Systems 153 APPENDIX 1 10 Solid Waste Disposal, FY2008-09 through FY2012-13 Source: NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Program, NC Solid Waste Management Annual Reports, County Per Capita Report, Fiscal Year 2012-2013; http://portal.ncdenr.org/c/document_library/get_file?p_l_id=4649434&folderId=15429422&name=DLFE-80542.pdf. County Waste Disposal Report, Person County (FY2012-13) Source: NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Section. Solid Waste Management Annual Reports, FY2012-2013; County Waste Disposal Report Fiscal Year 2012-2013. http://portal.ncdenr.org/web/wm/sw/swmar. Capacity of Landfills Serving Person County (FY2012-13) Source: NC Department of Environment and Natural Resources, Division of Waste Management, Solid Waste Section. Solid Waste Management Annual Reports, FY2012-13; Landfill Capacity Report Fiscal Year 2012-2013. http://portal.ncdenr.org/c/document_library/get_file?p_l_id=4649434&folderId=15429422&name=DLFE-80550.pdf. Health Data Maternal and Child Health Total Pregnancy, Fertility and Abortion Rates, Ages 15-44 (Single Years, 2008-2012) Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2010-2014). Pregnancy and Live Births. Pregnancy, Fertility, & Abortion Rates per 1,000 Population, by Race, by Age; http://www.schs.state.nc.us/SCHS/data/databook/. 2008-09 2009-10 2010-11 2011-12 2012-13 Person County 24,249 32,203 30,447 35,668 44,858 39,560 0.80 1.00 26 Bladen County 25,048 35,536 38,487 41,698 38,260 40,832 0.86 1.16 35 State of NC 7,257,428 9,910,031 9,395,457 9,467,045 9,443,380 9,149,130 1.07 0.94 -12 Location MSW Tons Managed 1991-92 Base Year Per Capita (1991-92) Per Capita Rate 2012-13 % Change Base Year to 2012-13 MSW Tons Disposed Granville County CDL Construction and demolition landfill Oxford 6.00 0.00 Uwharrie Environmental Regional Landfill Municipal solid waste landfill Mt. Gilead 5.75 0.00 Upper Piedmont Regional Environmental Landfill Municipal solid waste landfill Rougemont 38,971.31 0.00 Red Rock Disposal, LLC Municipal solid waste landfill Holly Springs 7.19 0.00 First Piedmont Corporation Ringgold Transfer Station Transfer station Ringgold (VA)569.97 569.97 Facility Facility Type Tons Received Tons TransferredLocation Facility Name Open Date Volume Overall Volume Overall Remaining Volume Overall Remaining in Tons Volume Overall Remaining in Years (Fiscal Year Tons) Granville County Construction and Demolition Landfill 1998 541,182.00 360,304.90 234,185.03 23.61 Uwharrie Environmental Regional Landfill 1995 33,785,715.00 18,830,689.00 13,947,654.51 16.90 Upper Piedmont Regional Landfill 1997 17,400,000.00 12,570,561.00 9,164,006.56 38.63 Red Rock Disposal, LLC 2001 18,992,799.00 16,469,303.00 8,986,393.00 148.49 154 APPENDIX 1 11 Pregnancy, Fertility and Abortion Rates, Ages 15-44, Stratified by Race/Ethnicity (Single Years, 2010-2012) Note: Bold type indicates an unstable rate based on a small number (fewer than 10 cases) Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2012-2014). Pregnancy and Live Births. Pregnancy, Fertility, & Abortion Rates per 1,000 Population, by Race, by Age; http://www.schs.state.nc.us/SCHS/data/databook/. Total Pregnancy, Fertility and Abortion Rates, Ages 15-19 (Single Years, 2008-2012) Note: Bold type indicates an unstable rate based on a small number (fewer than 10 cases) Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2008-2014). Pregnancy and Live Births. Pregnancy, Fertility, & Abortion Rates per 1,000 Population, by Race, by Age; http://www.schs.state.nc.us/SCHS/data/databook/. Pregnancy, Fertility and Abortion Rates, Ages 15-19, Stratified by Race/Ethnicity (Single Years, 2010-2012) Note: Bold type indicates an unstable rate based on a small number (fewer than 10 cases). Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2012-20114). Pregnancy and Live Births. Pregnancy, Fertility, & Abortion Rates per 1,000 Population, by Race, by Age; http://www.schs.state.nc.us/SCHS/data/databook/. 155 APPENDIX 1 12 Number of Teen Pregnancies (Ages 15-19) (Single Years, 2004-2012) Source: NC State Center for Health Statistics, North Carolina Health Data Query System. Pregnancy Data. North Carolina Reported Pregnancy Data (2004-2012), Counties and age groups as indicated; http://www.schs.state.nc.us/schs/data/preg/preg.cfm. High Parity and Short Interval Births (Single Five-Year Aggregate Period, 2008-2012) 1 Number at risk due high parity 2 Percent of all births with age of mother in category indicated 3 Number with interval from last delivery to conception of six months or less 4 Percent of all births excluding 1st pregnancies a - NC State Center for Health Statistics, County-level Data, County Health Data Book (2013), Pregnancy and Births, 2007-2011 Number At Risk NC Live Births due to High Parity by County of Residence; http://www.schs.state.nc.us/SCHS/data/databook/. b - NC State Center for Health Statistics, County-level Data, County Health Data Book (2013), Pregnancy and Births, 2007-2011 NC Live Births by County of Residence, Number with Interval from Last Delivery to Conception of Six Months or Less; http://www.schs.state.nc.us/SCHS/data/databook/. Smoking during Pregnancy Trend (Single Years, 2006-2012) Source: NC State Center for Health Statistics, Vital Statistics, Volume 1 (2006, 2007,-2008, 2009, 2010, 2011 and 2012): Population, Births, Deaths, Marriages, Divorces, (geography as noted), Mother Smoked; http://www.schs.state.nc.us/schs/data/vitalstats.cfm. Women Receiving Prenatal Care in the First Trimester (Single Years, 2006-2012) Source: NC State Center for Health Statistics, Basic Automated Birth Yearbook (BABY Book), North Carolina Residents (2006, 2007,-2008, 2009, 2010, 2011 and 2012) (geographies as noted): Table 6 (and others): County Resident Births by Month Prenatal Care Began, All Women; http://www.schs.state.nc.us/schs/births/babybook/. 156 APPENDIX 1 13 Low Birth-Weight Births (Five Year Aggregate Periods, 2006-2010 through 2008-2012) Note: Bold type indicates an unstable rate based on a small number (fewer than 20 cases). Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2012, 2013, 2014), Pregnancy and Births, Low and Very Low Weight Births; http://www.schs.state.nc.us/SCHS/data/databook/. Total Infant Deaths (Five-Year Aggregate Periods, 2002-2006 through 2008-2012) Note: Bold type indicates a likely unstable rate based on a small (fewer than 20) number of cases. Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2008-2014), Mortality, Infant Death Rates per 1,000 Live Births; http://www.schs.state.nc.us/SCHS/data/databook/. Infant Deaths, Stratified by Race/Ethnicity (Five-Year Aggregate Periods, 2006-2010 through 2008-2012) Note: Bold type indicates a likely unstable rate based on a small (fewer than 20) number of cases. Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2012-2014), Mortality, Infant Death Rates per 1,000 Live Births; http://www.schs.state.nc.us/SCHS/data/databook/. Total White, Non- Hispanic Black, Non- Hispanic Other Non- Hispanic Hispanic Total White, Non- Hispanic Black, Non- Hispanic Other Non- Hispanic Hispanic Total White, Non- Hispanic Black, Non- Hispanic Other Non- Hispanic Hispanic Person County 9.7 6.8 16.3 6.3 8.4 9.7 6.5 17.2 6.9 7.7 9.8 6.3 17.2 6.7 8.7 Bladen County 9.8 8.3 15.7 4.3 3.1 10.0 7.9 15.7 4.5 4.7 9.7 7.3 15.5 5.4 4.7 State of NC 9.1 7.7 14.4 9.3 6.3 9.1 7.7 14.3 9.4 6.5 9.0 7.6 14.1 9.3 6.5 Location 2007-20112006-2010 2008-2012 Percent of Low Birth Weight (≤ 2,500 Gram) Births No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate Person County Total2410.5 26 11.4 23 9.9 22 9.3 16 6.8 15 6.6 14 6.5Bladen County Total3113.7 29 12.9 30 13.5 28 13.1 19 9.2 15 7.8 15 8.0State of NC Total5,084 8.4 5,234 8.4 5,333 8.4 5,289 8.3 5,066 7.9 4,899 7.8 4,675 7.5 2005-2009Location2002-2006 2003-2007 2004-2008 2006-2010 2007-2011 2008-2012 Infant Deaths No. Rate No. Rate No. Rate Person County Total 16 6.8 15 6.6 14 6.5 White, Non-Hispanic 5 3.5 3 2.1 3 2.3 African American, Non-Hispanic 11 15.8 12 17.8 11 16.7 Other, Non-Hispanic 0 0 0 0 0 0.0 Hispanic 0 0 0 0 0 0.0 Bladen County Total 19 9.2 15 7.8 15 8.0 White, Non-Hispanic 2 2.0 2 2.2 4 4.6 African American, Non-Hispanic 12 17.2 10 14.9 10 15.3 Other, Non-Hispanic 1 14.5 1 14.9 0 0.0 Hispanic 4 12.6 2 6.8 1 3.6 State of NC Total 5,066 7.9 4,899 7.8 4,675 7.5 White, Non-Hispanic 2,074 5.9 2,001 5.7 1,918 5.6 African American, Non-Hispanic 2,208 14.7 2,129 14.3 2,064 14.0 Other, Non-Hispanic 187 6.3 188 6.2 181 5.9 Hispanic 597 5.8 581 5.8 512 5.3 Location 2006-2010 2007-2011 2008-2012 Infant Deaths 157 APPENDIX 1 14 Life Expectancy Life Expectancy at Birth, by Gender and Race (1990-1992 and 2010-2012) Source: NC State Center for Health Statistics, County-level Data, Life Expectancy, State and County Estimates, Life Expectancy: North Carolina 1990-1992 and 2010-2012, State and County; http://www.schs.state.nc.us/schs/data/lifexpectancy/. Leading Causes of Death Overall Age-Adjusted Mortality Rates for the 15 Leading Causes of Death (Single Five-Year Aggregate Period, 2008-2012 or as Noted)1 Note that all rates and corresponding rankings appearing in bold typeface are based on fewer than 20 deaths and should be considered unstable. 1 Rate = Number of events per 100,000 population, where the Standard = Year 2000 US Population a - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II, Leading Causes of Death, 2008, 2009, 2010, 2011, 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol1. b - NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. c - Calculated d - National Center for Health Statistics, National Vital Statistics Reports, Volume 61, Number 6 (October 10, 2012), Deaths, Preliminary data for 2011; http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf. Overall Male Female White African- American Overall Male Female White African- American Person County 75.5 70.6 80.4 76.7 72.8 76.9 74.0 79.8 77.3 75.8 Bladen County 72.4 67.8 76.9 74.1 69.4 75.7 72.7 78.5 76.8 73.5 State of NC 74.9 71.0 78.7 76.4 69.8 78.2 75.7 80.6 78.7 75.9 Location Life Expectancy in Years Person Born in 1990-1992 Person Born in 2010-2012 Number Rate Rank Number Rate Rank Number Rate Rank Rate Rank 1. Cancer 472 195.4 1 385 177.4 2 89,505 175.9 1 168.6 2 Trachea, Bronchus, and Lung 151 62.0 a 128 55.8 a 27,204 52.8 a 45.9 N/A Prostate 22 25.1 b 13 18.6 d 4,356 23.4 b 8.3 2 N/A Breast 29 21.9 c 26 21.9 b 6,357 22.2 c 12.0 2 N/A Colon, Rectum and Anus 45 19.1 d 41 19.3 c 7,561 14.9 d 15.3 N/A Pancreas 20 7.7 e 20 9.6 e 5,330 10.4 e 10.9 N/A 2. Diseases of the Heart 427 182.8 2 491 243.8 1 85,890 174.4 2 173.7 1 3. Cerebrovascular Disease 174 74.7 3 112 56.8 3 21,821 45.1 4 37.9 4 4. Chronic Lower Respiratory Disease 124 52.8 4 91 42.9 4 22,884 46.6 3 42.7 3 5. All Other Unintentional Injuries 61 28.9 5 69 36.9 5 14,168 29.4 5 38.0 5 6. Diabetes Mellitus 68 28.5 6 69 34.6 6 10,984 21.8 7 21.5 7 7. Alzheimer's Disease 56 24.8 7 50 26.7 8 13,746 29.3 6 24.6 6 8. Pneumonia and Influenza 47 20.3 8 30 15.7 10 8,710 18.0 8 15.7 8 9. Unintentional Motor Vehicle Injuries 32 18.0 9 60 33.9 7 6,875 14.3 10 10.9 N/A 10. Septicemia 42 17.8 10 32 14.5 11 6,597 13.4 11 10.5 11 11. Nephritis, Nephrotic Syndrome, and Nephrosis 38 16.0 11 52 25.2 9 8,795 18.0 8 13.4 9 12. Suicide 32 14.9 12 18 10.6 13 5,958 12.2 12 12.0 10 13. Chronic Liver Disease and Cirrhosis 32 13.2 13 28 13.2 12 4,926 9.3 13 9.7 12 14. Homicide 11 6.5 14 16 10.5 14 2,846 6.0 14 3.6 N/A 15. Acquired Immune Deficiency Syndrome 4 2.0 15 7 4.5 15 1,560 3.1 15 2.4 N/A Total Deaths All Causes (Some causes are not listed above)2,030 875.1 N/A 1,902 946.6 N/A 394,087 800.6 N/A 740.6 N/A Source:a a c a a c b b c d d United States (2011)State of NCRank/Cause of Death Person County Bladen County 158 APPENDIX 1 15 Changes in Leading Causes of Death, Person County (Between 2005-2009 and 2008-2012) a - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II, Leading Causes of Death, 2008, 2009, 2010, 2011, 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol1. b - Calculated Sex-Specific Age-Adjusted Death Rates for Leading Causes of Death (Single Five-Year Aggregate Period, 2008-2012) Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Source - NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. 2008-2012 2005-2009 1. Cancer 195.4 216.1 -9.6 2 +1 2. Diseases of the Heart 182.8 223.3 -18.1 1 -1 3. Cerebrovascular Disease 74.7 86.9 -14.0 3 n/c 4. Chronic Lower Respiratory Disease 52.8 52.7 +0.2 4 n/c 5. All Other Unintentional Injuries 28.9 33.7 -14.2 5 n/c 6. Diabetes Melllitus 28.5 31.7 -10.0 6 n/c 7. Alzheimer's Disease 24.8 16.8 +47.6 11 +4 8. Pneumonia and Influenza 20.3 29.6 -31.4 7 -1 9. Unintentional Motor Vehicle Injuries 18.0 26.2 -31.3 8 -1 10. Septicemia 17.8 19.7 -9.6 10 n/c 11. Nephritis, Nephrotic Syndrome and Nephrosis 16.0 24.9 -35.7 9 -2 12. Suicide 14.9 11.1 +34.2 13 +1 13. Chronic Liver Disease and Cirrhosis 13.2 13.5 -2.2 12 -1 14. Homicide 6.5 8.5 -23.5 14 n/c 15. Acquired Immune Deficiency Syndrome 2.0 3.4 -41.2 15 n/c Total Mortality Rate 875.1 985.4 -11.2 n/a n/a Source: a a b b b Rank ChangeRank / Cause of Death, 2008-2012 Mortality Rate Percent Rate Change Rank 2005-2009 Number Rate Number Rate Number Rate Number Rate Males Females 1. Cancer 264 256.2 208 153.0 213.0 234.1 172.0 139.7 221.4 145.0 2. Diseases of the Heart 218 231.2 209 143.1 244.0 297.9 247.0 202.8 222.3 138.1 3. Cerebrovascular Diseases 51 58.1 123 81.6 52.0 66.7 60.0 49.0 45.7 43.7 4. Chronic Lower Respiratory Disease 70 76.9 54 38.8 61.0 77.7 30.0 22.9 54.0 42.1 5. All Other Unintentional Injuries 41 42.8 20 18.2 33.0 41.1 36.0 34.9 39.1 21.1 6. Diabetes Mellitus 31 30.8 37 26.2 28.0 36.8 41.0 33.2 25.9 18.6 7. Alzheimer's Disease 14 N/A 42 27.8 12.0 N/A 38.0 30.4 23.3 32.4 8. Pneumonia and Influenza 25 30.4 22 14.5 14.0 N/A 16.0 N/A 20.7 16.4 9. Unintentional Motor Vehicle Injury 20 24.1 12 N/A 43.0 52.7 17.0 N/A 21.1 8.0 10. Septicemia 18 N/A 24 17.4 18.0 N/A 14.0 N/A 14.8 12.4 11. Nephritis, Nephrotic Syndrome and Nephrosis 15 N/A 23 16.1 25.0 28.1 27.0 21.7 22.0 15.4 12. Suicide 24 24.0 8 N/A 12.0 N/A 6.0 N/A 19.8 5.4 13. Chronic Liver Disease and Cirrhosis 19 N/A 13 N/A 14.0 N/A 14.0 N/A 13.2 6.0 14. Homicide 7 N/A 4 N/A 12.0 N/A 4.0 N/A 9.3 2.8 15. Acquired Immune Deficiency Syndrome 3 N/A 1 N/A 3.0 N/A 4.0 N/A 4.4 2.0 Total Deaths All Causes (Some causes are not listed above)1,005 1,057.3 1,025 736.3 943 1141.8 959 799.6 954.5 680.8 Cause of Death Person County Bladen County State of NC Rate Males Females Males Females 159 APPENDIX 1 16 Race-Specific Age-Adjusted Death Rates for Leading Causes of Death, Person County (Single Five-Year Aggregate Period, 2008-2012) Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Source - NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Three Leading Causes of Death by Age Group, Number of Deaths and Unadjusted Death Rates (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, Death Counts and Crude Death Rates per 100,000 for Leading Causes of Death, by Age Groups, NC, 2008-2012; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate 1. Cancer 339 189.9 131 223.5 1 N/A 0 N/A 0 N/A 472 195.4 2. Diseases of the Heart 315 181.4 105 191.6 5 N/A 0 N/A 0 N/A 427 182.8 3. Cerebrovascular Diseases 130 74.8 43 75.8 1 N/A 0 N/A 0 N/A 174 74.7 4. Chronic Lower Respiratory Disease 104 59.3 18 N/A 1 N/A 0 N/A 0 N/A 124 52.8 5. All Other Unintentional Injuries 44 31.1 16 N/A 1 N/A 0 N/A 0 N/A 61 28.9 6. Diabetes Mellitus 35 19.9 32 58.6 0 N/A 0 N/A 0 N/A 68 28.5 7. Alzheimer's Disease 43 25.1 12 N/A 1 N/A 0 N/A 0 N/A 56 24.8 8. Pneumonia and Influenza 39 22.5 7 N/A 1 N/A 0 N/A 0 N/A 47 20.3 9. Unintentional Motor Vehicle Injuries 22 19.2 8 N/A 1 N/A 0 N/A 0 N/A 32 18.0 10. Septicemia 30 17.2 12 N/A 0 N/A 0 N/A 0 N/A 42 17.8 11. Nephritis, Nephrotic Syndrome and Nephrosis 25 14.1 13 N/A 0 N/A 0 N/A 0 N/A 38 16.0 12. Suicide 30 20.1 1 N/A 0 N/A 0 N/A 0 N/A 32 14.9 13. Chronic Liver Disease and Cirrhosis 26 14.7 6 N/A 0 N/A 0 N/A 0 N/A 32 13.2 14. Homicide 7 N/A 4 N/A 0 N/A 0 N/A 0 N/A 11 N/A 15. Acquired Immune Deficiency Syndrome 1 N/A 3 N/A 0 N/A 0 N/A 0 N/A 4 N/A Total Deaths All Causes (Some causes are not listed above)1,476 864.2 530 947.1 14 N/A 0 N/A 0 N/A 2,030 875.1 American Indian, non-HispanicCause of Death Person County White, non-Hispanic African-American, non-Hispanic Other Races, non-Hispanic Hispanic Overall Person County Bladen County State of NC 00-19 1 Conditions originating in the perinatal Conditions originating in the perinatal Conditions originating in the perinatal period period period 2 Motor Vehicle Injuries Motor vehicle injuries Congenital anomalies (birth defects) Other Unintentional injuries 3 Diseases of the heart N/A Motor vehicle injuries Congenital anomalies (birth defects) 20-39 1 Other Unintentional Injuries Motor vehicle injuries Other Unintentional injuries 2 Motor Vehicle Injuries Other Unintentional injuries Motor vehicle injuries 3 Homicide Diseases of the heart Suicide 40-64 1 Cancer-All Sites Cancer-All Sites Cancer-All sites 2 Diseases of the heart Diseases of the heart Diseases of the heart 3 Chronic Lower Respiratory diseases Other Unintentional Injuries Other Unintentional injuries Other Unintentional Injuries 65-84 1 Cancer-All Sites Diseases of the heart Cancer-All sites 2 Diseases of the heart Cancer-All Sites Diseases of the heart 3 Chronic Lower Respiratory Diseases Cerebrovascular Disease Chronic lower respiratory diseases 85+1 Diseases of the heart Diseases of the heart Diseases of the heart 2 Cerebrovascular Disease Cancer-All Sites Cancer-All sites 3 Cancer-All Sites Cerebrovascular Disease Cerebrovascular Disease Cause of DeathAge Group Rank 160 APPENDIX 1 17 Total Cancer Overall Total Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008- 2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Overall Total Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Total Cancer Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Total Cancer Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 217.0 208.6 228.4 210.0 216.1 218.7 207.0 195.4 Bladen County 217.7 205.2 201.7 211.0 205.8 197.9 192.8 177.4 State of NC 197.7 196.4 194.9 192.5 185.6 183.1 179.7 175.9 Rate (Deaths per 100,000 Population) Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 339 189.9 131 223.5 1 N/A 1 N/A 264 256.2 208 153.0 472 195.4 Bladen County 248 182.9 130 175.6 6 N/A 1 N/A 213 234.1 172 139.7 385 177.4 State of NC 69,212 173.5 18,222 204.5 1,305 124.6 766 70.0 47,751 221.4 41,754 145.0 89,505 175.9 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 289.8 270.9 286.6 250.3 264.2 275.3 253.4 256.2 170.5 169.2 191.0 185.5 185.9 181.6 175.6 153.0 Bladen County 298.2 274.0 277.0 298.2 284.5 271.2 260.5 234.1 168.6 160.7 153.1 154.3 154.5 149.7 151.1 139.7 State of NC 252.6 250.0 247.5 243.4 235.3 232.0 227.4 221.4 162.0 161.2 160.4 158.7 152.5 150.3 147.5 145.0 Females Rate (Deaths per 100,000 Population) Location Males 161 APPENDIX 1 18 Gender Disparity Trend in Total Cancer Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Total Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Incidence Rates for All Counties by Specified Site (Years as Noted); http://www.schs.state.us.nc/SCHS/CCR/reports.html. Total Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Graph derived from data table above Location 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 Person County 400.7 428.6 407.4 455.6 451.1 498.4 463.2 491.9 503.2 503.7 523.0 514.9 Bladen County 333.9 338.9 352.3 399.7 371.9 414.3 388.1 409.3 441.1 402.7 435.9 427.1 State of NC 437.2 445.3 440.5 444.0 469.8 475.9 477.0 487.0 495.2 500.1 498.1 496.7 Rate (New cases per 100,000 Population) 162 APPENDIX 1 19 Lung Cancer Lung Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Lung Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Lung Cancer Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Lung Cancer Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 60.5 58.9 63.9 60.4 61.9 68.7 65.1 62.0 Bladen County 66.6 63.3 62.4 67.1 65.1 63.3 58.5 55.8 State of NC 59.9 59.8 59.6 59.1 57.0 55.9 54.5 52.8 Rate (Deaths per 100,000 Population) Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 113 62.6 38 65.5 0 N/A 0 N/A 88 83.4 63 46.0 151 62.0 Bladen County 89 62.3 33 39.7 5 N/A 1 N/A 85 87.3 43 34.0 128 55.8 State of NC 21,971 54.2 4,718 52.2 397 37.0 118 12.9 15,924 71.6 11,280 39.1 27,204 52.8 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 93.8 89.4 91.4 78.9 76.6 89.0 81.2 83.4 37.1 37.6 45.1 48.6 52.0 54.8 53.2 46.0 Bladen County 113.7 112.6 106.9 118.4 113.2 106.7 92.3 87.3 33.2 27.7 29.9 31.4 32.7 34.6 36.2 34.0 State of NC 85.6 84.3 83.3 81.9 78.6 76.7 74.4 71.6 41.7 42.3 42.7 42.7 41.5 40.8 40.0 39.1 Location Females Rate (Deaths per 100,000 Population) Males 163 APPENDIX 1 20 Gender Disparity Trend in Lung Cancer Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Lung Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Incidence Rates for All Counties by Specified Site (Years as Noted); http://www.schs.state.us.nc/SCHS/CCR/reports.html. Lung Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Graph derived from data table above Location 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 Person County 64.4 66.9 59.7 65.8 62.7 68.9 72.7 85.8 90.6 90.7 95.0 87.9 Bladen County 50.9 55.3 60.0 70.9 68.3 76.2 76.2 77.8 77.1 70.8 79.0 72.5 State of NC 69.3 69.7 68.0 69.3 69.7 73.8 75.0 75.8 76.3 75.9 74.8 73.4 Rate (New cases per 100,000 Population) 164 APPENDIX 1 21 Prostate Cancer Prostate Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) a - NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. b - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II: Leading Causes of Death, 2009, 2010, 2011 and 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol2. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Prostate Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Prostate Cancer Mortality, by Race/Ethnicity (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 45.1 42.0 37.0 26.0 27.3 31.9 26.0 25.1 Bladen County 34.6 25.5 22.6 22.2 16.3 21.3 21.2 18.6 State of NC 29.9 29.1 28.3 27.3 25.7 25.5 24.3 23.4 Source:a a a a b b b b Overall Rate (Deaths per 100,000 Male Population) Number Rate Number Rate Number Rate Number Rate Number Rate Person County 13 N/A 9 N/A 0 N/A 0 N/A 22 25.1 Bladen County 6 N/A 7 N/A 0 N/A 0 N/A 13 N/A State of NC 2,887 19.0 1,378 51.6 54 18.9 37 13.0 4,356 23.4 Location White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Overall Deaths, Number and Rate (Deaths per 100,000 Male Population) 165 APPENDIX 1 22 Prostate Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Incidence Rates for All Counties by Specified Site (Years as Noted); http://www.schs.state.us.nc/SCHS/CCR/reports.html. Prostate Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Graph derived from data table above Breast Cancer Breast Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Location 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 Person County 138.4 153.7 146.5 186.3 166.8 195.9 166.0 155.3 155.0 150.7 148.8 148.8 Bladen County 105.3 116.0 114.6 130.1 117.4 118.4 113.6 115.9 125.5 118.3 116.5 118.7 State of NC 147.3 152.5 151.2 152.0 154.7 156.1 153.2 153.8 158.8 158.3 153.7 150.6 Rate (New cases per 100,000 Population) Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 17.8 20.7 23.7 26.6 15.5 25.7 25.0 21.9 Bladen County 40.3 41.4 34.9 34.0 16.0 25.7 24.5 21.9 State of NC 25.7 25.5 25.2 24.8 23.5 23.2 22.8 22.2 Rate (Deaths per 100,000 Female Population) 166 APPENDIX 1 23 Breast Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Breast Cancer Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Breast Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Incidence Rates for All Counties by Specified Site (Years as Noted); http://www.schs.state.us.nc/SCHS/CCR/reports.html. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 19 N/A 10 N/A 0 N/A 0 N/A 0 N/A 29 21.9 29 21.9 Bladen County 17 N/A 9 N/A 0 N/A 0 N/A 0 N/A 26 21.9 26 21.9 State of NC 4,677 21.3 1,595 29.0 80 11.9 63 9.1 58 N/A 6,357 22.2 6,415 22.4 Location Deaths, Number and Rate (Deaths per 100,000 Female Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall Location 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 Person County 143.2 143.5 131.2 140.7 128.3 146.8 123.8 127.6 123.9 115.5 119.0 125.6 Bladen County 127.7 114.4 122.1 132.9 105.8 125.8 98.1 89.1 119.1 94.8 106.2 156.5 State of NC 145.9 148.2 147.1 147.3 144.9 148.2 147.2 149.6 151.9 154.5 155.9 157.4 Rate (New cases per 100,000 Population) 167 APPENDIX 1 24 Breast Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Graph derived from data table above Colon Cancer Colon, Rectum, Anus Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Colon, Rectum, Anus Cancer Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 21.6 18.0 22.3 20.8 22.1 21.3 20.6 19.1 Bladen County 19.9 18.2 17.1 18.9 19.6 18.3 19.8 19.3 State of NC 18.6 18.2 17.8 17.3 16.5 16.0 15.5 14.9 Rate (Deaths per 100,000 Population) 168 APPENDIX 1 25 Colon, Rectum, Anus Cancer Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Colon, Rectum, Anus Cancer Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Colon, Rectum, Anus Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Incidence Rates for All Counties by Specified Site (Years as Noted); http://www.schs.state.us.nc/SCHS/CCR/reports.html. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 31 17.7 14 N/A 0 N/A 0 N/A 24 23.9 21 16.2 45 19.1Bladen County 22 16.4 19 N/A 0 N/A 0 N/A 21 25.0 20 15.7 41 19.3State of NC 5,533 14.0 1,865 21.2 102 9.7 61 6.1 3,928 18.1 3,633 12.6 7,561 14.9 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall Location 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 Person County 40.3 39.7 38.0 43.7 46.8 43.6 42.1 45.2 48.1 49.2 53.2 55.1 Bladen County 42.5 44.8 44.0 46.9 44.3 48.3 39.7 37.6 44.4 44.4 46.8 48.1 State of NC 48.4 48.4 48.3 48.2 52.5 48.6 48.4 47.4 46.8 45.5 43.4 41.5 Rate (New cases per 100,000 Population) 169 APPENDIX 1 26 Colon, Rectum, Anus Cancer Incidence Rate Trend (Five-Year Aggregate Periods, 1996-2000 through 2007-2011) Graph derived from data table above Heart Disease Overall Heart Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Overall Heart Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 237.7 231.1 227.0 225.3 223.3 213.3 197.4 182.8 Bladen County 296.0 282.9 272.0 271.6 274.6 264.9 259.1 243.8 State of NC 226.8 217.9 210.7 202.2 191.7 184.9 179.3 174.4 Rate (Deaths per 100,000 Population) 170 APPENDIX 1 27 Heart Disease Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Heart Disease Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Gender Disparity Trend in Heart Disease Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Cerebrovascular Disease Cerebrovascular Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 315 181.4 105 191.6 5 N/A 2 N/A 218 231.2 209 143.1 427 182.8 Bladen County 303 243.7 182 258.4 6 N/A 0 N/A 244 297.9 247 202.8 491 243.8State of NC 67,453 172.1 16,843 198.4 1,103 122.8 491 53.6 44,701 222.3 41,189 138.1 85,890 174.4 OverallWhite, Non-Hispanic African American, Non-Hispanic Other Races, Non-HispanicLocation Hispanic Deaths, Number and Rate (Deaths per 100,000 Population) Male Female 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 316.3 308.1 296.6 289.0 294.0 265.1 238.8 231.2 175.3 171.2 174.8 178.3 175.9 176.9 164.2 143.1 Bladen County 373.4 360.6 333.8 334.1 327.8 319.7 316.3 297.9 240.2 227.0 224.9 225.2 231.7 222.8 213.0 202.8 State of NC 285.5 275.3 267.0 256.6 244.9 237.2 229.4 222.3 183.0 174.9 168.7 161.2 151.9 145.8 141.6 138.1 MalesLocation FemalesRate (Deaths per 100,000 Population) Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 99.8 94.4 91.7 88.3 86.9 81.4 82.7 74.7 Bladen County 92.8 86.9 83.9 84.3 77.3 66.4 61.5 56.8 State of NC 64.7 61.1 57.6 54.4 50.5 47.8 46.0 45.1 Rate (Deaths per 100,000 Population) 171 APPENDIX 1 28 Cerebrovascular Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Cerebrovascular Disease Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Cerebrovascular Disease Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 130 74.8 43 75.8 N/A N/A N/A N/A 51 58.1 123 81.6 174 74.7 Bladen County 63 50.5 48 69.6 N/A N/A N/A N/A 52 66.7 60 49.0 112 56.8 State of NC 16,519 42.5 4,871 59.3 274 32.6 157 17.6 8,792 45.7 13,029 43.7 21,821 45.1 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 106.9 100.8 84.6 77.2 72.3 54.8 62.8 58.1 95.2 90.5 93.7 92.0 90.8 92.0 90.4 81.6 Bladen County 96.1 90.0 95.4 102.5 97.0 80.4 69.8 66.7 89.0 84.8 75.4 72.8 63.1 54.7 52.2 49.0 State of NC 65.8 62.1 58.9 55.9 52.0 48.7 46.8 45.7 63.0 59.5 55.7 52.4 48.6 46.3 44.5 43.7 Rate (Deaths per 100,000 Population) Males FemalesLocation 172 APPENDIX 1 29 Gender Disparity Trend in Cerebrovascular Disease Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Chronic Lower Respiratory Disease CLRD/COPD Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. CLRD/COPD Mortality Rate Trend (Five-Year Aggregate Periods, Person County, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 55.3 56.7 52.6 49.0 52.7 54.0 54.5 52.8 Bladen County 58.8 63.3 67.2 67.1 67.1 60.5 54.0 42.9 State of NC 46.9 47.1 47.5 47.8 47.0 46.4 46.6 46.6 Rate (Deaths per 100,000 Population) 173 APPENDIX 1 30 CLRD/COPD Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in CLRD/COPD Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Gender Disparity Trend in CLRD/COPD Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above All Other Unintentional Injury (Non-Motor Vehicle Injury) All Other Unintentional Injury Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 104 59.3 18 N/A 1 N/A 1 N/A 70 76.9 54 38.8 124 52.8 Bladen County 61 45.2 30 41.4 0 N/A 0 N/A 61 77.7 30 22.9 91 42.9 State of NC 20,275 51.3 2,364 28.7 181 21.6 64 9.4 10,662 54.0 12,222 42.1 22,884 46.6 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 82.3 79.6 70.2 60.4 67.7 71.5 78.4 76.9 39.2 43.2 42.3 41.9 43.2 43.5 41.3 38.8 Bladen County 90.7 99.2 105.3 105.4 110.4 106.0 100.9 77.7 38.6 40.5 43.5 43.2 38.0 33.3 27.6 22.9 State of NC 61.0 60.1 59.5 58.9 57.1 55.5 54.9 54.0 38.6 39.5 40.4 41.3 41.0 41.1 41.7 42.1 Rate (Deaths per 100,000 Population)Males FemalesLocation Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 29.5 29.7 35.6 33.4 33.7 29.8 33.5 28.9 Bladen County 28.6 33.8 35.6 29.5 31.7 35.1 33.9 36.9 State of NC 26.0 27.0 27.8 28.4 28.6 28.6 29.2 29.4 Rate (Deaths per 100,000 Population) 174 APPENDIX 1 31 All Other Unintentional Injury Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above. All Other Unintentional Injury Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in All Other Unintentional Injury Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 44 31.1 N/A N/A N/A N/A N/A N/A 41 42.8 20 18.2 61 28.9 Bladen County 51 48 N/A N/A N/A N/A N/A N/A 33 41.1 36 34.9 69 36.9 State of NC 11,761 33.8 1,862 19.8 256 19.1 289 12.0 8,385 39.1 5,783 21.1 14,168 29.4 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 42.7 43.7 52.2 50.8 53.7 45.2 50.4 42.8 21.5 22.1 24.4 21.2 19.4 19.1 19.9 18.2 Bladen County 42.1 48.0 51.8 39.4 41.3 42.3 39.8 41.1 17.7 21.2 21.0 19.5 22.2 27.7 30.0 34.9 State of NC 34.7 36.1 36.8 37.8 38.4 38.4 38.8 39.1 18.3 19.0 19.8 20.2 20.1 20.2 20.9 21.1 Rate (Deaths per 100,000 Population)Males FemalesLocation 175 APPENDIX 1 32 Gender Disparity Trend in All Other Unintentional Injury Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Diabetes Diabetes Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Diabetes Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 27.4 26.5 27.3 32.0 31.7 32.3 32.2 28.5 Bladen County 47.6 49.6 49.7 46.9 43.6 41.0 37.9 34.6 State of NC 27.6 27.1 26.4 25.2 23.6 22.5 22.0 21.8 Rate (Deaths per 100,000 Population) 176 APPENDIX 1 33 Diabetes Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Diabetes Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Gender Disparity Trend in Diabetes Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Alzheimer’s Disease Alzheimer's Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 35 19.9 32 58.6 0 N/A 1 N/A 31 30.8 37 26.2 68 28.5 Bladen County 31 24.3 38 57.5 0 N/A 0 N/A 28 36.8 41 33.2 69 34.6 State of NC 6,911 17.5 3,752 43.8 229 24.3 92 9.2 5,571 25.9 5,413 18.6 10,984 21.8 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 26.1 26.6 34.3 38.7 40.5 41.8 37.9 30.8 28.8 27.7 24.5 28.9 27.7 26.9 28.6 26.2 Bladen County 47.2 50.5 56.0 58.9 50.7 44.8 45.1 36.8 47.3 47.6 42.5 37.0 37.9 36.9 33.0 33.2 State of NC 30.4 30.2 30.0 28.9 27.3 26.4 26.0 25.9 25.3 24.5 23.5 22.2 20.7 19.4 18.8 18.6 Rate (Deaths per 100,000 Population) Males FemalesLocation Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 14.5 11.7 12.5 10.4 16.8 20.8 26.8 24.8 Bladen County 17.7 20.7 22.8 24.5 27.4 26.8 24.6 26.7 State of NC 27.1 27.7 28.3 28.7 28.3 28.5 29.0 29.3 Rate (Deaths per 100,000 Population) 177 APPENDIX 1 34 Alzheimer's Disease Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Alzheimer's Disease Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Alzheimer's Disease Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 43 25.1 12 N/A 1 N/A 0 N/A 14 N/A 42 27.8 56 24.8 Bladen County 34 28.0 16 N/A 0 N/A 0 N/A 12 N/A 38 30.4 50 26.7 State of NC 11,685 30.3 1,861 26.1 151 24.9 49 9.3 3,818 23.3 9,928 32.4 13,746 29.3 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 12.2 11.9 8.7 5.0 N/A N/A N/A N/A 16.3 12.4 15.4 13.5 19.1 23.2 31.5 27.8 Bladen County 9.2 13.3 14.9 14.2 N/A N/A N/A N/A 20.5 2.8 25.3 28.4 31.2 29.7 29.6 30.4 State of NC 21.6 22.0 22.2 22.2 22.3 22.7 22.7 23.3 29.6 30.3 31.1 31.8 31.3 31.3 32.2 32.4 Rate (Deaths per 100,000 Population)Males FemalesLocation 178 APPENDIX 1 35 Pneumonia and Influenza Pneumonia and Influenza Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Pneumonia and Influenza Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Pneumonia and Influenza Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Pneumonia and Influenza Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 25.9 33.9 30.5 31.0 29.6 27.4 20.1 20.3 Bladen County 23.7 19.8 16.6 12.9 13.5 11.4 14.5 15.7 State of NC 23.3 22.5 21.4 20.3 19.4 18.6 17.9 18.0 Rate (Deaths per 100,000 Population) Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 39 22.5 7 N/A 1 N/A 0 N/A 25 30.4 22 14.5 47 20.3 Bladen County 12 N/A 17 N/A 1 N/A 0 N/A 14 N/A 16 N/A 30 15.7 State of NC 7,152 18.4 1,395 17.2 93 11.5 70 7.4 3,819 20.7 4,891 16.4 8,710 18.0 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 22.1 30.6 25.3 28.8 27.9 N/A N/A 30.4 27.3 33.9 32.2 31.2 30.0 27.6 17.9 14.5 Bladen County 19.5 16.0 15.2 12.6 N/A N/A N/A N/A 25.7 21.7 16.6 13.0 N/A N/A N/A N/A State of NC 28.0 26.6 25.4 23.9 22.6 21.6 20.9 20.7 20.5 20.1 19.0 18.1 17.4 16.8 16.1 16.4 Rate (Deaths per 100,000 Population)Males FemalesLocation 179 APPENDIX 1 36 Gender Disparity Trend in Pneumonia and Influenza Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Unintentional Motor Vehicle Injury Unintentional Motor Vehicle Injury Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Unintentional Motor Vehicle Injury Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 27.7 26.3 29.0 29.2 26.2 23.4 20.6 18.0 Bladen County 37.6 34.3 34.2 35.2 36.4 40.2 38.8 33.9 State of NC 19.3 19.1 19.1 18.6 17.6 16.7 15.5 14.3 Rate (Deaths per 100,000 Population) 180 APPENDIX 1 37 Unintentional Motor Vehicle Injury Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Unintentional Motor Vehicle Injury Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Unintentional Motor Vehicle Injury Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Septicemia Septicemia Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 22 19.2 8 N/A 1 N/A 1 N/A 20 24.1 12 N/A 32 18.0 Bladen County 36 37.0 23 37.6 0 N/A 1 N/A 43 52.7 17 N/A 60 33.9 State of NC 4,697 14.5 1,476 14.3 211 12.3 491 11.9 4,882 21.1 1,993 8.0 6,875 14.3 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 35.1 35.2 41.5 40.2 37.4 34.9 30.7 24.1 21.9 18.9 17.3 19.7 N/A N/A N/A N/A Bladen County 46.8 40.6 48.2 55.7 62.5 66.5 63.0 52.7 28.6 27.8 20.3 17.0 N/A N/A N/A N/A State of NC 27.4 27.2 27.3 26.7 25.6 24.6 22.9 21.1 11.8 11.6 11.4 10.8 10.1 9.3 8.6 8.0 Rate (Deaths per 100,000 Population)Males FemalesLocation Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 16.7 19.4 21.1 20.3 19.7 21.0 19.3 17.8 Bladen County 22.2 21.8 21.2 19.4 20.1 18.0 16.0 14.5 State of NC 14.5 14.4 14.2 14.2 13.8 13.7 13.6 13.4 Rate (Deaths per 100,000 Population) 181 APPENDIX 1 38 Septicemia Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Septicemia Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Septicemia Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 30 17 12 N/A 0 N/A 0 N/A 18 N/A 24 17 42 18 Bladen County 19 N/A 12 N/A 0 N/A 1 N/A 18 N/A 14 N/A 32 15 State of NC 4,786 12.3 1,657 19.7 80 9.1 74 6.1 2,997 14.8 3,600 12.4 6,597 13.4 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 18.1 22.6 26.2 26.8 25.6 24.5 23.4 23.4 16.1 17.8 17.7 15.3 N/A 18.7 15.6 15.6 Bladen County 33.6 30.2 32.0 27.8 29.8 N/A N/A N/A 15.9 17.6 16.0 16.0 N/A N/A N/A N/A State of NC 15.7 15.7 15.5 15.6 15.1 15.1 15.0 15.0 13.6 13.6 13.4 13.2 12.8 12.7 12.6 12.6 Rate (Deaths per 100,000 Population) Males FemalesLocation 182 APPENDIX 1 39 Gender Disparity Trend in Septicemia Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Kidney Disease Kidney Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Kidney Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 20.6 21.0 21.9 23.7 24.9 23.8 19.1 16.0 Bladen County 24.7 22.1 21.9 20.2 22.7 23.8 26.1 25.2 State of NC 17.9 18.2 18.5 18.8 18.7 18.9 18.6 18.0 Rate (Deaths per 100,000 Population) 183 APPENDIX 1 40 Kidney Disease Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Kidney Disease Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Kidney Disease Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Suicide Suicide Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) a - NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. b - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II: Leading Causes of Death, 2009, 2010, 2011 and 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol2. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 25 14.1 13 N/A 0 N/A 0 N/A 15 N/A 23 16.1 38 16.0 Bladen County 24 19.5 28 37.9 0 N/A 0 N/A 25 28.1 27 21.7 52 25.2 State of NC 5,685 14.6 2,904 35.1 142 17.3 64 7.2 4,273 22.0 4,522 15.4 8,795 18.0 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 13.1 12.5 17.8 22.3 24.9 29.3 25.5 N/A 23.8 24.7 22.7 23.1 23.6 20.8 15.7 16.1 Bladen County 21.1 20.2 20.2 17.7 N/A 29.9 32.3 28.1 25.5 22.1 21.6 20.5 23.2 19.6 21.1 21.7 State of NC 21.0 21.5 21.6 22.3 22.4 22.9 22.7 22.0 15.9 16.2 16.5 16.6 16.4 16.4 16.0 15.4 Rate (Deaths per 100,000 Population)Males FemalesLocation Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 17.8 14.1 10.4 11.7 11.1 11.5 14.5 14.9 Bladen County 13.3 12.7 9.5 7.2 9.6 11.2 10.7 10.6 State of NC 11.6 11.6 11.7 11.9 12.0 12.1 12.1 12.2 Source:a a a a b b b b Rate (Deaths per 100,000 Population) 184 APPENDIX 1 41 Suicide Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Suicide Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Suicide Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 30 20.1 1 N/A 0 N/A 1 N/A 24 24.0 8 N/A 32 14.9 Bladen County 14 N/A 3 N/A 0 N/A 1 N/A 12 N/A 6 N/A 18 10.6 State of NC 5,184 15.4 493 4.8 134 7.7 147 4.1 4,580 19.8 1,378 5.4 5,958 12.2 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 29.4 20.7 16.2 20.8 N/A N/A 23.4 24.0 7.7 8.4 5.5 3.9 N/A N/A N/A N/A Bladen County 23.4 18.7 12.2 7.6 N/A N/A N/A N/A 5.0 7.8 7.0 6.8 N/A N/A N/A N/A State of NC 19.3 19.2 18.9 19.1 19.5 19.6 19.6 19.8 4.8 4.9 5.2 5.4 5.3 5.3 5.3 5.4 Location Rate (Deaths per 100,000 Population) Males Females 185 APPENDIX 1 42 Gender Disparity Trend in Suicide Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Liver Disease Liver Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Liver Disease Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 11.7 13.0 11.4 11.3 13.5 12.7 12.2 13.2 Bladen County 9.1 10.4 10.7 11.1 13.8 14.8 14.5 13.2 State of NC 8.8 8.8 8.9 9.1 9.1 9.1 9.3 9.3 Rate (Deaths per 100,000 Population) 186 APPENDIX 1 43 Liver Disease Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Liver Disease Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Liver Disease Mortality Rate, Person County (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Homicide Homicide Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) a - NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age- Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. b - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II: Leading Causes of Death, 2009, 2010, 2011 and 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol2. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 26 14.7 6 N/A 0 N/A 0 N/A 19 N/A 13 N/A 32 13.2 Bladen County 22 16.9 6 N/A 0 N/A 0 N/A 14 N/A 14 N/A 28 13.2 State of NC 4,022 10.2 746 7.2 84 6.5 74 4.7 3,236 13.2 1,690 6.0 4,926 9.3 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 19.4 22.0 18.9 16.6 20.7 18.7 17.8 18.7 5.3 5.2 4.3 6.0 N/A N/A N/A N/A Bladen County 16.4 18.5 18.0 16.6 N/A N/A N/A N/A 2.6 3.5 4.3 6.2 N/A N/A N/A N/A State of NC 12.6 12.5 12.7 12.9 12.9 13.0 13.2 13.2 5.6 5.6 5.7 5.8 5.8 5.8 5.9 6.0 Rate (Deaths per 100,000 Population) Males FemalesLocation Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 6.4 7.1 7.6 7.3 8.5 9.9 8.7 6.5 Bladen County 10.3 9.4 11.4 11.2 11.8 14.1 13.4 10.5 State of NC 7.2 7.2 7.1 7.2 7.0 6.6 6.3 6.0 Source:a a a a b b b b Rate (Deaths per 100,000 Population) 187 APPENDIX 1 44 Homicide Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above Homicide Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in Homicide Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Note: This parameter is not graphed because the four most recent data points were suppressed. Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 7 N/A 4 N/A 0 N/A 0 N/A 7 N/A 4 N/A 11 N/A Bladen County 4 N/A 12 N/A 0 N/A 0 N/A 12 N/A 4 N/A 16 N/A State of NC 1,068 3.4 1,397 13.1 134 7.3 247 5.9 2,174 9.3 672 2.8 2,846 6.0 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 9.9 12.2 12.1 12.4 N/A N/A N/A N/A 2.9 1.8 3.0 2.1 N/A N/A N/A N/A Bladen County 18.6 18.1 21.9 21.5 N/A N/A N/A N/A 2.7 1.3 1.4 1.4 N/A N/A N/A N/A State of NC 11.0 10.9 11.0 11.0 10.8 10.2 9.8 9.3 3.3 3.3 3.2 3.3 3.2 3.0 2.9 2.8 Location Rate (Deaths per 100,000 Population)Males Females 188 APPENDIX 1 45 AIDS AIDS Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) a - NC State Center for Health Statistics, County Health Data Books (2007-2014), Mortality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. b - NC State Center for Health Statistics, Statistics and Reports, Vital Statistics, NC Vital Statistics Volume II: Leading Causes of Death, 2009, 2010, 2011 and 2012; http://www.schs.state.nc.us/data/vital.cfm#vitalvol2. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. AIDS Mortality Rate Trend (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Graph derived from data table above AIDS Mortality, by Race/Ethnicity and Sex (Single Five-Year Aggregate Period, 2008-2012) Source: NC State Center for Health Statistics, County Health Data Book (2014), Mortality, 2008-2012 Race/Ethnicity Specific and Sex-Specific Age-Adjusted Death Rates by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Gender Disparity Trend in AIDS Mortality Rate (Five-Year Aggregate Periods, 2001-2005 through 2008-2012) Source: NC State Center for Health Statistics, County-level Data, County Health Data Books (2007-2014), Mortality, NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates, by County; http://www.schs.state.nc.us/SCHS/data/databook/. Note: The use of bold type or the use of "n/a" in lieu of a numeral indicates a likely unstable rate based on a small (fewer than 20) number of cases. Location 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 3.8 2.6 3.1 3.0 3.4 2.8 2.8 2.0 Bladen County 7.7 7.1 8.9 8.2 8.9 7.7 7.1 4.5 State of NC 5.2 5.1 4.7 4.4 4.2 3.9 3.5 3.1 Source:a a a a b b b b Rate (Deaths per 100,000 Population) Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Person County 1 N/A 3 N/A 0 N/A 0 N/A 3 N/A 1 N/A 4 N/A Bladen County 0 N/A 7 N/A 0 N/A 0 N/A 3 N/A 4 N/A 7 N/A State of NC 324 0.9 1,165 11.3 18 N/A 53 2.2 1,065 4.4 495 2.0 1,560 3.1 Location Deaths, Number and Rate (Deaths per 100,000 Population) White, Non-Hispanic African American, Non-Hispanic Other Races, Non-Hispanic Hispanic Male Female Overall 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 Person County 5.7 3.5 5.3 5.0 N/A N/A N/A N/A 1.8 1.8 0.9 1.1 N/A N/A N/A N/A Bladen County 10.6 11.8 15.2 13.8 N/A N/A N/A N/A 5.1 2.8 2.8 2.8 N/A N/A N/A N/A State of NC 7.4 7.1 6.6 6.1 5.9 5.4 4.8 4.4 3.1 3.1 2.9 2.7 2.7 2.5 2.3 2.0 Rate (Deaths per 100,000 Population)Males FemalesLocation 189 APPENDIX 1 46 Morbidity Adult Diagnosed Diabetes Prevalence Estimate Trend (Six Single Years, 2006 through 2011) Note: The prevalence of diagnosed diabetes and selected risk factors by county was estimated using data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) and data from the U.S. Census Bureau's Population Estimates Program. Three years of data were used to improve the precision of the year-specific county-level estimates of diagnosed diabetes and selected risk factors. Source: Centers for Disease Control and Prevention, Diabetes Data and Trends, County Level Estimates of Diagnosed Diabetes - of Adults in North Carolina, 2006-2011; http://apps.nccd.cdc.gov/ddtstrs/default.aspx. Adult Diagnosed Obesity Prevalence Estimate Trend (Six Single Years, 2006 through 2011) Note: The prevalence of diagnosed diabetes and selected risk factors by county was estimated using data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) and data from the U.S. Census Bureau's Population Estimates Program. Three years of data were used to improve the precision of the year-specific county-level estimates of diagnosed diabetes and selected risk factors. Source: Centers for Disease Control and Prevention, Obesity Data and Trends, County Level Estimates of Diagnosed Obesity - of Adults in North Carolina, 2006-2011; http://apps.nccd.cdc.gov/ddtstrs/default.aspx. Prevalence of Overweight and Obesity in Children Ages 2-4 (2007-2012)1 Source: Eat Smart, Move More, Data on Children and Youth in NC, North Carolina Nutrition and Physical Activity Surveillance System (NC-NPASS), NC-NPASS Data (2007-2012), counties and age groups as noted; http://www.eatsmartmovemorenc.com/Data/ChildAndYouthData.html. 1 NC-NPASS data for children ages 2 to 4 are reflective of the population at 185% of the federal poverty level. Approximately 85 to 95% of the children included in the NC-NPASS sample for ages 2 to 4 are WIC participants. Since children are not eligible to participate in WIC once they become 5 years old, the sample size for NC-NPASS data received from the child health clinics was not adequate to calculate county-specific rates for children age 5 and older. Note: Figures denoted in bold type indicate percentages based on fewer than 10 cases. Overweight (Formerly "At Risk for Overweight") = BMI greater than or equal to the 85th percentile but less than the 95th percentile. Obese (Formerly "Overweight") = BMI greater than or equal to the 95th percentile. Persons Served by Area Mental Health Programs (2008-2013)1 Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health (Data Item 519); http://data.osbm.state.nc/pls/linc/dyn_linc_main.show. 1 All clients of a community-based Area Program for mental health, developmental disabilities, and drug and alcohol abuse active at the beginning of the state fiscal year plus all admissions during the year. Also included are persons served in three regional mental health facilities. Multiple admissions of the same client are counted multiple times. County of residence is reported at the time of admission. North Carolina data include clients reported to reside out-of-state and sometimes contains individuals of unknown county of residence. No. % No. % No. % No. % No. % No. % Person County 2,760 9.1 3,032 9.9 3,154 10.2 3,532 11.0 3,988 11.6 3,708 10.7 Bladen County 2,662 10.1 2,684 10.3 2,851 10.8 3,347 12.2 3,849 12.6 3,929 12.8 State Total 585,000 8.8 617,000 9.0 642,000 9.1 673,000 9.2 688,000 9.3 688,000 9.3 2006 2007 2008 2009 2010 2011 Estimated Prevalence, Number and Percent (Age-adjusted, Age 18 and Older) Location # % # % # % # % # % # % Person County 9,150 32.8 8,879 31.9 8,389 29.9 9,310 33.1 9,592 32.5 9,843 33.3 Bladen County 7,073 29.3 7,263 30.7 7,853 33.2 8,814 37.1 9,495 36.2 9,387 35.7 State of NC n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Location 2011 Estimated Prevalence, Number and Percent (Age-adjusted, Age 18 or Older) 2006 2007 2008 2009 2010 Overweight Obese Overweight Obese Overweight Obese Overweight Obese Overweight Obese Overweight Obese Person County 17.7 16.2 16.2 15.9 19.9 16.2 16.6 16.6 13.1 18.2 16.5 14.7 Bladen County 14.7 14.7 18.9 16.9 16.1 17.6 17.0 17.3 17.0 15.9 14.9 15.9 State of NC 15.7 15.3 16.3 15.4 15.8 15.4 16.1 15.6 16.2 15.7 14.9 14.5 2011 2012Location Prevalence of Overweight and Obesity in Children Ages 2-4, by Percent 2007 2008 2009 2010 2008 2009 2010 2011 2012 2013 Person County 1,236 1,335 1,617 1,990 1,895 2,117 Bladen County 1,725 1,257 1,327 903 1,069 1,523 State of NC 306,907 309,155 332,796 360,180 315,284 306,080 Location Number of Persons Served 190 APPENDIX 1 47 Persons Served in NC State Psychiatric Hospitals (2008-2013)1 Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health (Data Item 516); http://data.osbm.state.nc/pls/linc/dyn_linc_main.show. 1 Sometimes referred to as "episodes of care", these counts reflect the total number of persons who were active (or the resident population) at the start of the state fiscal year plus the total of first admissions, readmissions, and transfers-in which occurred during the fiscal yerar at the three state alcohol and drug treatment centers. Excluded are visiting patients and outpatients. Multiple admissions of the same client are counted multiple times. County of residence is reported at the time of admission. North Carolina data include clients reported to reside out-of-state. Persons Served in NC State Developmental Centers (2008-2013) Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health (Data Item 517); http://data.osbm.state.nc/pls/linc/dyn_linc_main.show. Persons Served in NC State Alcohol and Drug Abuse Treatment Centers (2008-2013)1 Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health (Data Item 518); http://data.osbm.state.nc/pls/linc/dyn_linc_main.show. 1 Sometimes referred to as "episodes of care", these counts reflect the total number of persons who were active (or the resident population) at the start of the state fiscal year plus the total of first admissions, readmissions, and transfers-in which occurred during the fiscal yerar at the three state alcohol and drug treatment centers. Excluded are visiting patients and outpatients. Multiple admissions of the same client are counted multiple times. County of residence is reported at the time of admission. North Carolina data include clients reported to reside out-of-state. 2008 2009 2010 2011 2012 2013 Person County 85 51 45 48 29 21 Bladen County 38 32 30 27 26 20 State of NC 14,643 9,643 7,188 5,754 4,572 3,964 Location Number of Persons Served 2008 2009 2010 2011 2012 2013 Person County 13 15 13 12 10 9 Bladen County 0 1 1 1 0 1 State of NC 1,409 1,404 1,375 1,355 1,340 1,331 Location Number of Persons Served 2008 2009 2010 2011 2012 2013 Person County 15 30 35 71 31 24 Bladen County 7 11 14 15 11 23 State of NC 4,284 4,812 4,483 4,590 4,265 4,343 Location Number of Persons Served 191 APPENDIX 2 1 2014 PERSON COUNTY COMMUNITY HEALTH SURVEY (“Chapter Six: Community Health Survey” from the comprehensive 2014 Person County Community Health Assessment, Secondary Data and Community Health Survey Report) Methodology The 2014 Person County Community Health Survey was conducted primarily electronically, using Survey Monkey, but hard copies of the survey also were made available in both English and Spanish. A stratified convenience sample approach was used. Community health assessment team members distributed the survey link through email distribution lists and contacts as well as through other means (meetings, various correspondence, etc.) Hard copy surveys were made available at various meetings, churches, worksites, community events, public sites, etc. Responses collected through hard copies were entered into Survey Monkey by two team members. Concerted efforts were made to get responses from a demographic representation of the county. Demographic data was reviewed about half-way through the survey process. This guided the team in further efforts to more specifically target underrepresented groups. Information was placed in the local newspaper to invite the public to access the survey online at http://health.personcounty.net or by obtaining a paper copy at the Health Department. Copies of the survey are appended to this report. Data was gathered from 624 surveys. An analysis of this data was conducted by a contract consultant. Efforts were made to provide the survey via link and/or hard copy to the following groups, populations and sites:  County and city employees  Various churches  Various civic organizations  Health Department clients (including Hispanic clients)  School system and charter school employees  Employees and students at the community college  Person County United Way board and contacts  Public housing staff and families  Person Family Medical & Dental Centers, Inc. employees and clients  Daycare homes and centers  Preschool parents  Healthy Personians Partnership members  Person County Medical Reserve Corps volunteers  Various industries and businesses  Assisted living facilities and nursing homes  American Association of Retired Persons  Person County Senior Center  4-H families  Extension Community Association members and families  Local farmers and the agriculture community  Hispanic Tienda  Various groups to get a better sampling of residents ages 60 and above, men, African-Americans and Hispanics  Person County Freedom House Recovery Center employees  Department of Social Services clients  General public (via Facebook, websites, local media, library, email, etc.) 192 APPENDIX 2 2 Note: In an effort to avoid redundancy, questions regarding weight status, physical activity, healthy eating and use of recreational facilities were not included in the community health survey. Such questions were part of a market research project phone survey that was conducted in the fall of 2013. Data from that survey is included in this CHA Report where appropriate. Survey Participants Survey participants were asked to provide demographic information about themselves by selecting appropriate responses from lists describing categories of age, gender, race and ethnicity, education level, employment status, household income, and how many people that income supported. This demographic information was collected in order to assess how well the survey participants represented the general population of Person County. The table below compares the demographic profile of the 2014 survey respondents to the general population according to the 2010 US Census. Demographic Comparison of 2014 Survey Respondents with the Overall Person County Population (2010 Census) Demographic Category 2014 Survey Participants County Population1 # % % Gender (n=599) Male 141 23.5 48.5 Female 458 76.5 51.5 Race (n=598) White/Caucasian 453 75.8 68.3 African American/Black 123 20.6 27.0 Asian 0 0.0 0.3 Native American 8 0.8 0.7 Two or More Races 9 1.5 1.5 Other 8 1.3 3.7 Hispanic/Latino Origin 30 5.1 4.0 Age 18-19 3 0.5 2.5 20-29 79 13.1 10.2 30-39 117 15.1 12.2 40-49 127 21.0 14.4 50-59 145 24.0 15.5 60-64 55 9.1 6.6 65-69 48 7.9 4.8 70-79 39 6.5 6.5 80-85 9 1.5 1.9 85 and Older 1 0.2 1.9 Other Unemployed 23 3.8 9.7 2 Household Income < $20,000 65 11.5 16.4 3 Household Income ≥ $50,000 337 59.9 n/a Less than HS Diploma/GED 34 5.7 17.9 4 Bachelor’s Degree or Higher 253 42.3 14.5 Sources: 1 County data are 2010 US Census counts unless otherwise noted 2 NC Employment Security Commission average, 2012 3 Percent population at or below poverty level, 2008-2012 ACS via US Census Bureau 4 Person County Community Profile, www.personcounty.net 193 APPENDIX 2 3 A brief analysis of the information in the demographic comparison reveals that certain population groups were either over-sampled or under-sampled in the 2014 survey.  Females were significantly over sampled.  Whites were oversampled and African Americans were under-sampled.  Persons of Hispanic/Latino ethnicity were adequately sampled.  The middle-aged segments of the local population, especially persons aged 40-46, were over-sampled.  The segments of the population that were unemployed and those that had household income < $20,000 appear to have been significantly under-sampled.  The segment of the population with less than a HS diploma or GED was significantly under-sampled, and the segment of the population with a Bachelor’s degree or higher was significantly over-sampled. The survey respondents can be generally characterized as predominately female, ethnically diverse, older, more affluent and more highly educated than the general population. It will be important to keep this profile in mind when interpreting and applying the results of the survey. Survey Results The order of some of the questions in the following analysis may differ from their order in the actual survey, as topics have been rearranged for clarity. In most examples the actual survey question number is noted parenthetically (e.g., Qn). Where possible (i.e., when questions and answer choices match adequately) the results of Person County Community Health Surveys conducted in 2003, 2007, and/or 2011 are displayed in the table along with the 2014 results. If the individual answer choices do not match adequately, responses from other years are discussed as appropriate in bullet points rather than displayed in the table. For convenience in identifying the 2014 responses in tables incorporating data from other surveys, the 2014 data have been highlighted in yellow. It should be noted that year-to-year differences in response rates for questions on convenience-sample surveys such as these are not strictly comparable, since the methodology and composition of the respondent pool differ significantly from one survey to another. Nevertheless it is still instructive to note the broad similarities (or differences) in community responses over time. 194 APPENDIX 2 4 Demographic Questions What is your Zip code? (Q35; n=605) ZIP Code 2007 2011 2014 # % # % # % 27573 (Roxboro) 272 43.0 248 32.4 188 31.1 27574 (Roxboro) 222 35.2 323 42.2 244 40.3 27583 (Timberlake) 60 9.5 71 9.3 79 13.1 27541 (Hurdle Mills) 22 3.5 67 8.7 38 6.3 27343 (Semora) 17 2.7 12 1.6 17 2.8 27572 (Rougemont) 16 2.5 29 3.8 25 4.1 27291 (Leasburg) 9 1.4 8 1 9 1.5 27565 (Oxford) 5 0.8 1 0.1 1 0.2 27703 (Durham) 2 0.3 1 0.1 0 0.0 Other n/a n/a n/a n/a 4 0.7 • More than 71% of 2014 respondents resided in Roxboro, a lower proportion compared to previous years. How old are you? (Q36; n=604) Age 2014 # % 18-19 3 0.5 20-29 79 13.1 30-39 98 16.2 40-49 127 21.0 50-59 145 24.0 60-64 55 9.1 65-69 48 7.9 70-79 39 6.5 80-85 9 1.5 85 or older 1 0.2  Slightly less than 30% of 2014 survey respondents were younger than age 40, compared to comparable figures of 37% in 2003 and 41% in 2007.  Approximately 16% of the 2014 respondents were 65 or older, compared to 13% in 2003, 15% in 2007, and 19% in 2011. Are you male or female? (Q37; n=599) Gender 2003 2007 2011 2014 # % # % # % # % Male 134 22.4 168 25.5 236 30.5 141 23.5 Female 436 73.0 490 74.4 538 69.5 458 76.5 195 APPENDIX 2 5 • A large majority of survey respondents (~77%) were female, similar to large female majorities polled in previous survey cycles, though a higher proportion of females were surveyed in 2014 than in any previous survey. What do you consider your race? (Q39; n=598) Race 2011 2014 # % # % Black/African American 180 23.6 123 20.6 Asian/Pacific Islander 0 0.0 0 0.0 Native American 6 0.8 5 0.8 White 557 73.0 453 75.8 Other race not listed here 20 2.6 8 1.3 Two or more races n/a n/a 9 1.5  Non-white persons comprised approximately 24% of the 2014 survey sample, a lower proportion than in 2007 (38%) or 2011 (27%). Are you of Hispanic, Latino, or Spanish origin? (Q38; n=592) Hispanic Origin 2011 2014 # % # % Yes 38 5.1 30 5.1 No 706 94.9 562 94.9  Among both 2011 and 2014 survey participants, 5.1% of the respondents considered themselves to be of Hispanic/Latino origin. In 2007, 2.6% of the respondents were Hispanic/Latino, although the question was asked in a different way (i.e., it was a racial category, not a separate question about ethnicity). What is the highest level of school, college or training that you have finished? (Q40; n=598) Educational Level 2007 2011 2014 # % # % # % Less than High School 54 8.2 22 2.9 10 1.7 9th - 12th Grade, no diploma n/a n/a 33 4.3 24 4.0 High School Diploma or GED 273 41.6 161 21.0 90 15.1 Associate’s Degree or Vocational Training 140 21.3 155 20.3 131 21.9 Some college (no degree) n/a n/a 147 19.2 86 14.4 Bachelor's Degree 100 15.2 147 19.2 131 21.9 Graduate Degree or Higher 63 9.6 97 12.7 122 20.4 Other 27 4.1 3 0.4 4 0.7 196 APPENDIX 2 6  In the 2014 survey, 5.7% of the respondents had less than a high school diploma, compared to 7.3% in 2003, 8.2% in 2007, and 7.2% in 2011.  A college, graduate or professional degree had been earned by 42.3% of 2014 respondents, compared to 50% in 2003, 24.8% in 2007 and 31.9% in 2011. What was your total household income last year, before taxes? (Q41; n=563) Household Income 2014 # % Less than $20,000 65 11.5 $20,000 to $29,999 43 7.6 $30,000 to $39,999 65 11.5 $40,000 to $49,999 41 7.3 $50,000 to $59,999 50 8.9 $60,000 to $69,000 51 9.1 $70,000 to $79,000 59 10.5 $80,000 to $99,000 74 13.1 $100,000 or more 115 20.4  In 2014, 11.5% of respondents had a household income of less than $20,000, compared to 23.1% in that category in 2003, 29.9% in 2007 and 16.3% in 2011.  Also in 2014, 26.4% of respondents had a household income between $20,000 and $50,000, compared to 33.4% in 2007 and 35.2% in 2011.  Finally in 2014, 61.7% of respondents had a household income that was $50,000 or greater, compared to 36.7% in 2007, and 48.5% in 2011. How many people does this income support? (Q42; n=578) Household Size 2014 # % 1 person 97 16.8 2 people 206 35.6 3 or 4 people 236 40.8 5 or more people 39 6.7  Household income that supported three or four people was the most common response (40.8%) to this question. 197 APPENDIX 2 7 What is your employment status? (Q43; n=604) Employment 2003 2007 2011 2014 # % # % # % # % Employed Full-Time 346 58.0 407 60.7 481 61.8 421 69.7 Employed Part-Time 40 6.7 60 8.9 69 8.9 50 8.3 Retired 86 14.4 81 12.1 137 17.6 87 14.4 Unemployed 37 6.2 53 7.9 35 4.5 23 3.8 Disabled 30 3.3 45 6.7 22 2.8 11 1.8 Student 8 1.3 21 3.1 17 2.2 14 2.3 Homemaker 17 2.8 21 3.1 17 2.2 12 2.0 Self-Employed n/a n/a n/a n/a 16 2.1 20 3.3  In 2014, 78.0% of respondents were employed full- or part-time, compared to 64.7% in 2003, 69.6% in 2007 and 70.7 in 2011.  In 2014, 14.4% of respondents were retired, compared to 14.4% in 2003, 12.1% in 2007 and 17.6% in 2011.  In 2014, 3.8% of respondents were unemployed, a lower proportion than in any of the three previous surveys.  In 2014 a smaller proportion of respondents were disabled (1.8%) than in any of the three previous surveys. Do you have any kind of medical health insurance coverage? (Q44; n=599) Health Insurance 2014 # % Yes 549 91.7 No 50 8.3  The vast majority of 2014 respondents (91.7%) reported that they did have medical health insurance coverage, and 8.3% reported that they did not have such insurance coverage.  For a discussion of the demographics of uninsured respondents, see the Health Resources section of this report. Does your current medical health insurance cover prescription drugs? (Q45; n=595) Prescription Coverage 2014 # % Yes 533 89.6 No 62 10.4  The majority of respondents (89.6%) reported that they had health insurance that included prescription drugs. 198 APPENDIX 2 8 Do you use the Internet? (Q46; n=601) Internet Usage 2014 # % Yes 547 91.0 No 54 9.0 • Not surprisingly, the majority of 2014 survey respondents (91%) use the Internet. Community Problems and Issues Health Problems Survey participants were presented an alphabetized list of 20 health problems and asked to select, in no particular order, the five they thought had the greatest overall impact on health in Person County. The list of responses below is arranged in descending order of the frequency with which a named problem was chosen in 2014. Health Concern 2007 2011 2014 Rank # % Rank # % Rank # % Cancer 1 412 62.8 1 538 69.2 1 499 80.1 Obesity/Overweight 3 344 52.4 2 494 63.5 2 384 61.6 Heart Disease/Heart Attacks 2 378 57.6 3 461 59.3 3 369 59.2 Substance abuse n/a n/a n/a n/a n/a n/a 4 351 56.3 Diabetes 4 321 48.9 4 411 52.8 5 342 54.9 Mental Health 7 239 36.4 6 284 36.5 6 206 33.1 Teenage Pregnancy 6 253 38.6 7 249 32.0 7 164 26.3 Alzheimer’s disease 1 n/a n/a n/a n/a n/a n/a 8 161 25.8 Aging Problems 5 313 47.7 5 378 48.6 n/a n/a n/a Lung Disease 10 109 16.6 9 118 15.2 9 135 21.7 Stroke 9 119 18.1 8 166 21.3 10 97 15.6 Motor Vehicle Injuries 2 11 106 16.2 12 99 12.7 11 77 12.4 Sexually Transmitted Diseases 8 120 18.3 10 104 13.4 12 64 10.3 Accidental injuries NOT involving vehicles 3 17 44 6.7 10 104 13.4 13 58 9.3 Kidney Disease 15 62 9.5 15 73 9.4 14 53 8.5 Infectious/Contagious Diseases 16 57 8.7 14 73 9.4 15 48 7.7 Dental Health 14 65 9.9 13 80 10.3 16 44 7.1 HIV/AIDS 13 87 13.3 17 46 5.9 17 30 4.8 Liver Disease 21 17 3.2 20 11 1.4 18 14 2.2 Other 22 14 2.1 19 15 1.9 19 12 1.9 Infant Death 20 36 5.5 21 7 0.9 20 7 1.1 1 Alzheimer's was included in the description of Aging Problems in previous years 2 Category was listed as Motor Vehicle Accidents in previous years 3 Category was "Other Injuries" in 2003  Since 2007, cancer consistently has been the most commonly identified health concern. The percentage of respondents selecting it has increased each year; 80.1% of participants chose it in 2014, up from 62.8% in 2007 and 69.2% in 2011.  The second and third most commonly identified health problems have traded places: heart disease was the second most common health concern in 2007 and it was third during the next two cycles. Obesity/overweight was third in 2007 and was ranked second 199 APPENDIX 2 9 in 2011 and 2014. More than half of respondents identify obesity/overweight as a health concern; in 2014 it was chosen by 61.6% of respondents. Heart disease was selected by 59.2% of 2014 Survey respondents.  Substance abuse, not previously an option on the list of health concerns, was the fourth most commonly selected health concern in 2014, chosen by 56.3% of respondents.  Diabetes was the fifth most commonly identified health concern in 2014; it ranked 4th in both 2007 and 2011. The percentage of respondents selecting it has increased each year: from 48.9% in 2007, to 52.8 in 2011, to 54.9% in 2014.  The percentages of respondents choosing mental health as a concern have declined over time (from 36.4% in 2007 to 33.1% in 2014), as have the percentages of respondents selecting teenage pregnancy (38.6% in 2007, 32.0 in 2011, and 26.3% in 2014).  Although the list of health concerns was very different in 2003 (when health concerns were listed together with unhealthy behaviors), cancer was chosen as a concern by 48.8% of respondents, obesity was chosen by 44%, teen pregnancy by 31.8%, and diabetes by 26.7%. Heart disease (co-listed with stroke) was ranked lower on the 2003 list, selected by 22.9%. Mental health was much lower on the list as well, selected by only 14.5% of respondents. Unhealthy Behaviors Survey participants were presented an alphabetized list of 17 unhealthy behaviors and asked to select, in no particular order, the five they thought had the greatest overall impact on health in Person County. The list of responses below is arranged in descending order of the frequency with which a named problem was chosen in 2014. Unhealthy Behaviors 2007 2011 2014 Rank # % Rank # % Rank # % Drug Abuse 1 540 81.1 1 585 75.2 1 520 83.5 Alcohol Abuse 2 494 74.2 2 522 67.1 2 390 62.6 Lack of exercise/poor physical fitness 7 229 34.4 3 399 51.3 3 360 57.8 Poor Eating Habits 4 307 46.1 3 399 51.3 4 340 54.6 Smoking/Tobacco Use 3 373 56.0 5 391 50.3 5 312 50.1 Lack of parenting skills n/a n/a n/a 6 266 34.2 6 266 42.7 Not going to doctor for preventive check-ups and screenings 5 267 40.1 7 247 31.7 7 218 35.0 Having unsafe sex 6 244 36.6 8 186 24.0 8 166 26.6 Reckless/drunk driving 8 188 28.2 8 186 24.0 9 147 23.6 Violent, angry behavior 9 147 22.1 10 171 22.0 10 115 18.5 Suicide 14 53 8.0 12 75 9.6 11 61 9.8 Not going to dentist for preventive checkups and cleaning 10 126 18.9 11 101 13.0 12 60 9.6 Poor preparation for disasters and emergencies n/a n/a n/a 15 44 5.7 13 45 7.2 Not using child safety seats 12 79 11.9 17 41 5.3 14 35 5.6 Not using seatbelts 11 103 15.5 13 67 8.6 15 29 4.7 Not getting prenatal care 13 76 11.4 14 46 5.9 16 27 4.3 Not getting immunizations to prevent disease 15 44 6.6 16 42 5.4 17 24 3.9  Since 2007, the most commonly identified unhealthy behavior was drug abuse, chosen consistently by more than 75% of the survey respondents; in 2014, 83.5% of participants 200 APPENDIX 2 10 selected it, the highest percentage since 2003.  The second most commonly identified unhealthy behavior since 2007 has been alcohol abuse, though the percentage of respondents selecting it decreased each year: from 74.2% in 2007, to 67.1% in 2011, to 62.6% in 2014.  Lack of exercise was of relatively greater concern to more recent survey respondents (who ranked it #3 in both 2011 and 2014) compared to 2007 respondents (who ranked it #7). An increasing percentage of participants selected it: 34.4% in 2007, 51.3% in 2011, and 57.8%, in 2014.  Poor eating habits and smoking/tobacco use were the next most commonly identified unhealthy behaviors, selected by more than 50% of respondents in both 2011 and 2014.  The lack of parenting skills option was identified as an important unhealthy behavior by an increasing percentage of respondents: 34.2% in 2011 and 42.7% in 2014.  Although, as mentioned earlier, the 2003 list of unhealthy behaviors looked quite different, some similarities in responses are notable: Drug use was the second most commonly identified issue, selected by 44.6% of respondents, and alcohol abuse was chosen by 36.4% of respondents. Tobacco use was selected by 25.1% of respondents. Lack of exercise and poor eating habits were lower on the list, identified by 23.9 and 18.1% of respondents, respectively. Community Issues Survey participants were presented an alphabetized list of 23 community issues and asked to select, in no particular order, the five they thought had the greatest overall impact on quality of life in Person County. The list of responses below is arranged in descending order of the frequency with which a named problem was chosen in 2014. 201 APPENDIX 2 11 Community Concerns 2007 2011 2014 Rank # % Rank # % Rank # % Unemployment/underemployment 1 340 51.4 1 482 62.0 1 343 55.1 Low income/poverty 4 254 38.4 5 274 35.2 2 316 50.7 Gang activity 2 291 44.0 2 352 45.2 3 240 38.5 Affordability of health services 3 280 42.4 3 312 40.1 4 207 33.2 Crime 1 17 86 13.0 4 307 39.5 4 207 33.2 Lack of recreational facilities 8 155 23.4 9 162 20.8 6 183 29.4 Dropping out of school 5 238 36.0 7 206 26.5 7 173 27.8 Lack of counseling/mental health services/ support groups n/a n/a n/a 11 137 17.6 7 173 27.8 Availability of healthy food choices in restaurants/grocery stores 9 145 21.9 9 162 20.8 9 167 26.8 Neglect and abuse 7 197 29.8 8 189 24.3 10 141 22.6 Lack of/inadequate health insurance 6 213 32.2 6 208 26.7 11 138 22.2 Affordability of housing 2 12 131 19.8 12 130 16.7 12 116 18.6 Racism/discrimination 13 107 16.2 14 101 13.0 13 113 18.1 Transportation options 11 134 20.3 17 74 9.5 14 93 14.9 Availability of child care 10 142 21.5 15 81 10.4 15 80 12.8 Pollution (air, water, land) 16 87 13.2 16 75 9.6 16 76 12.2 Unsafe schools n/a n/a n/a 13 119 15.3 17 68 10.9 Lack of healthcare providers 15 91 13.8 18 67 8.6 18 57 9.1 Unsafe/unmaintained roads n/a n/a n/a 19 59 7.6 18 57 9.1 Lack of culturally appropriate services for minorities 18 78 11.8 23 46 5.9 20 52 8.3 Disaster preparedness 14 97 14.7 21 44 6.9 21 42 6.7 Homelessness 19 76 11.5 22 49 6.3 22 41 6.6 Animal control issues/rabies 20 68 10.3 20 55 7.1 23 32 5.1 1 – Listed as “Violent Crime” in 2007 2 – Listed as “inadequate/Unaffordable Health Insurance” in 2007 • In each of the three surveys presented, the most commonly identified community issue was unemployment/underemployment, with more than half of respondents selecting it among their top five issues. A lower proportion of respondents selected it in 2014 (55.1%) than in 2011 (62.0%). (Note, however, that the unemployed segment of the Person County population was significantly under-sampled in the 2014 survey.) • In 2014 the second most commonly chosen community concern (~50%) was low income/poverty, which has risen up the ranks since 2007 and 2011, when it ranked 4th and 5th respectively and garnered approximately 36% of the responses. • Gang activity was ranked as the third greatest community concern in 2014, chosen by 38.5% respondents, a decrease from approximately 45% in both 2007 and 2011. • The lack of /inadequate health insurance option fell from a ranking of 6th in 2007 and 2011 to 11th in 2014, having been chosen by 32.2% of respondents in 2007, 26.7% in 2011, and 22.2% in 2014. • Lack of recreational facilities has risen in significance among survey respondents since 2007, when 23.4% of respondents listed it among concerns; in 2014, 29.4% selected it. • Although the 2003 Community Issues list was quite different and had fewer options, underemployment topped the list, with 76.6% of respondents selecting it. Health insurance affordability was second that year, chosen by 69.0% of the respondents, followed by low income/poverty at 52.5% and dropping out of school at 50.0%. 202 APPENDIX 2 12 Personal Health A portion of the Person County Community Survey collected information on respondents’ personal health behaviors. The results of this portion of the survey offer some insight into lifestyle factors that affect the health of individuals in Person County. Note: When participants were allowed to select more than one response for a question, the percent reported in the table is a frequency among all responses and does not indicate how often each response was chosen in combination with any other response. The total of the percent column therefore may be greater than 100. Where do you get most of your health-related information? Please choose only one. (Q4; n=608) Source of health information 2007 2011 2014 # % # % # % Doctor/Nurse 336 51.0 470 61.1 387 63.7 Friends and Family 117 17.8 119 15.5 57 9.4 Internet 63 9.6 70 9.1 84 13.8 Newspaper/Magazine/TV 74 11.2 52 6.8 24 3.9 Health Department 27 4.1 26 3.4 29 4.8 Pharmacist 7 1.1 15 2.0 11 1.8 Hospital 12 1.8 5 0.7 2 0.3 Church 6 0.9 5 0.7 1 0.2 Other 8 1.2 3 0.4 10 1.6 School 7 1.1 3 0.4 2 0.3 Help Line 2 0.3 n/a n/a 1 0.2 • Almost 64% of respondents reported that they seek health information from a doctor or nurse, a higher percentage than reported doing so in 2007 or 2011. • While family and friends were the second most common source of health information in both 2007 and 2011, among 2014 respondents the Internet was the second most common source, with 13.8% using it as their primary source of health care information. Where do you go most often when you are sick? Please choose only one. (Q5; n=608) Health Care Provider 2007 2011 2014 # % # % # % Doctor’s Office 545 82.8 590 76.6 458 75.3 Urgent Care Center n/a n/a 80 10.4 61 10.0 Person Family Medical and Dental Clinic 42 6.4 29 3.8 35 5.8 Hospital 26 4.0 26 3.4 13 2.1 Health Department 26 4.0 24 3.1 12 2.0 Other 19 2.9 21 2.7 4 0.7 • More than three-quarters of 2014 respondents (75.3%) reported that they seek care in a doctor's office when sick, a lower percentage than in 2007 (82.8%) or 2011 (76.6%). 203 APPENDIX 2 13 • Urgent care centers are the next most common care providers. • In 2014, participants were given the option to indicate that they do not usually go to any sort of health care provider when sick; 25 participants (4.1%) answered thusly. Is this place you go when you are sick in Person County? (Q6; n=605) Provider In-County 2014 # % Yes 507 83.8 No 98 16.2 • On previous surveys, participants were asked to identify where their primary health care provider was located; in 2007, 72.9% of respondents’ providers were located in Roxboro and another 16.9% were in Durham. In 2011, 82.0% were in Roxboro and 16.2% were in Durham. • In 2014, the question was simplified to ask whether or not the respondent’s preferred provider was in Person County; in this iteration, 83.8% of participants received their health care from Person County providers. About how long has it been since you last visited a doctor for a routine checkup? (Do not include any times you visited the doctor because you were sick or pregnant.) (Q7; n=612) How long since last checkup 2003 2007 2011 2014 # % # % # % # % Within the Past Year 450 76.5 479 73.5 536 69.9 456 74.5 1-2 Years Ago 84 14.3 106 16.3 149 19.4 105 17.2 3-5 Years Ago 23 3.9 31 4.8 49 6.4 21 3.4 5 or More Years Ago 19 3.2 22 3.4 27 3.5 25 4.1 I have never had a routine checkup. n/a n/a 14 2.1 6 0.8 5 0.8 • Nearly three-quarters of 2014 respondents had been to the doctor for a routine check-up in the past year, a proportion up from 2011 and roughly the same as 2003 and 2007. 204 APPENDIX 2 14 Was there a time in the past 12 months when you needed medical care but could not get it? (Choose as many answers as you need to.) (Q8; n=611). Healthcare access issues 2007 2011 2014 # % # % # % I didn’t have health insurance and couldn't afford the cost 38 40.9 51 48.6 40 44.9 My insurance didn't cover what I needed. 17 18.3 15 14.3 15 16.9 My share of the cost (deductible/co-pay) was too high. 32 34.4 31 29.5 37 41.6 Provider would not take my insurance or Medicaid. 6 6.5 4 3.8 4 4.5 I didn’t have transportation to get there. 4 4.3 4 3.8 5 5.6 I didn’t know where to go. 6 6.5 3 2.9 3 3.4 I couldn’t get an appointment/it took too long to get one 17 18.3 16 15.2 11 12.4 The doctor wasn't taking new patients. n/a n/a 5 4.8 5 5.6 Other 19 20.4 5 4.8 n/a n/a  In 2007, 14% of respondents reported having had trouble accessing medical care in the past year; in 2011 13.7% reported having had access issues.  Although the structure of this question changed in 2014, approximately 14.6% of respondents reported having had trouble accessing needed medical care; 522 respondents (85.4%) indicated that they did NOT have access issues.  Among those who did have trouble getting needed medical care, the primary reason typically has been lack of health insurance: more than 40% of those with access issues in 2007, 2011 and 2014 identified this as the main barrier. The second most frequently reported barrier was usually the high cost of care (identified by an increasing proportion of respondents), followed by insurance not covering the care needed and difficulties in getting an appointment (though this barrier has been identified by fewer participants each cycle). Was there a time in the past 12 months when you could not get a medically necessary prescription? (Choose as many answers as you need to.) (Q9; n=609) Prescription Access Issues 2007 2011 2014 # % # % # % I didn’t have health insurance. 20 29.0 36 41.9 35 43.2 My insurance didn’t cover what I needed. 18 26.1 19 22.1 26 32.1 My share of the cost (deductible/co-pay) was too high. 38 55.1 34 39.5 32 39.5 Pharmacy would not take my insurance or Medicaid. 0 0.0 3 3.5 2 2.5 I had problems with Medicare D coverage. 2 2.9 2 2.3 3 3.7 I didn’t have a way to get there. 2 2.9 2 2.3 2 2.5 Yes, because I didn’t know where to go. n/a n/a n/a n/a 4 4.9 Other 12 17.4 4 4.6 n/a n/a  In 2011, 11.2% of respondents had trouble accessing a necessary prescription, up from 10.4% in 2007.  Although the structure of this question changed in 2014, approximately 13.3% of respondents reported they had trouble getting a needed prescription; 528 respondents (86.7%) indicated that they did not have prescription access issues.  Among those who did have a problem filling a prescription, the primary reason in 2014 was lack of health insurance (identified by 43.2% of respondents, an increase from 205 APPENDIX 2 15 previous surveys) followed by the cost being too high (with the percentage of respondents selecting this barrier having dropped since 2007). Inadequate health insurance was identified as a barrier by 32.1% of those who had trouble accessing care, an increase from 22.1% in 2011. About how long has it been since you last visited a dentist for a routine checkup? (Do NOT include times you visited the dentist because of an emergency.) Choose only one. (Q10; n=607) How long since last dental checkup 2003 2007 2011 2014 # % # % # % # % Within the Past Year 414 70.8 401 61.1 522 67.9 437 72.0 1-2 Years Ago 82 14 106 16.2 122 15.9 82 13.5 3-5 Years Ago 42 7.2 67 10.2 56 7.3 42 6.9 5 or More Years Ago 40 6.8 62 9.5 58 7.5 39 6.4 Never had a Routine Checkup 7 1.2 20 3.0 11 1.4 7 1.2 • In 2014, 72.0% of respondents had been to the dentist for a routine checkup within the past year, a higher rate than reported on any of the previous three surveys. • A higher proportion of respondents reported never having had a routine dental check-up (1.2%) compared to the proportion who reported never having had a routine check-up from a doctor (0.8%). Was there a time during the past 12 months when you needed to get dental care but could not? (Q11; n=613) Dental Access Issues 2007 2011 2014 # % # % # % I didn't have dental insurance. 75 58.1 74 69.8 67 59.3 My insurance didn't cover what I needed. 10 7.8 14 13.2 19 16.8 My share of the cost (deductible/co-pay) was too high. 65 50.4 25 23.6 26 23.0 Dentist would not take my insurance or Medicaid. 14 10.9 4 3.8 4 3.5 I didn't have transportation to get there. 9 7.0 4 3.8 2 1.8 I didn't know where to go. 3 2.3 2 1.9 5 4.4 It took too long to get an appointment. 21 16.3 8 7.5 8 7.1 Dentist wasn't taking new patients n/a n/a 3 2.8 2 1.8 Other 8 6.2 6 5.7 n/a n/a  In 2011, 13.9% of respondents had trouble accessing necessary dental care, down from 19.8% in 2007.  Although the structure of this question changed in 2014, approximately 18.4% of respondents had trouble getting dental care; 500 respondents (81.6%) indicated that they did not have dental care access issues.  Among those who did have a problem getting dental care, the primary barrier reported in 2014 was lack of dental insurance (identified by 59.3% of respondents, a decrease from the 2011 survey) followed by the cost being too high (the percentage of respondents selecting this barrier has dropped since 2007). Inadequate insurance was identified as a 206 APPENDIX 2 16 barrier by 16.8% of those who had trouble accessing care, an increase from 7.8% in 2007 and 13.2% in 2011. If a friend or family member needed counseling for a mental health or a drug/alcohol abuse problem, who would you tell them to call or talk to? (Choose as many answers as you need to.) (Q12; n=613) MH/DD/SA Resources 2003 2007 2011 2014 # % # % # % # % Person Counseling Center/Family Care Network 178 33.6 285 42.5 287 36.9 232 37.8 Private Counselor or Therapist 107 20.2 120 17.9 151 19.4 206 33.6 Doctor 74 14 122 18.2 161 20.7 229 37.4 Minister/Religious Official 45 8.5 106 15.8 93 12.0 193 31.5 Person Memorial Hospital 47 8.9 15 2.2 20 2.6 26 4.2 School Counselor n/a n/a 19 2.8 22 2.8 102 16.6 Support Group (e.g., AA, Al-Anon) n/a n/a 62 9.2 58 7.5 132 21.5 Other n/a n/a 19 2.8 10 1.3 31 5.1 Don't Know 79 14.9 51 7.6 87 11.2 91 14.8 • The response choices offered for this question have changed over the years to include more named options. In 2003, Person Counseling Center and private counselor/therapist significantly dominated the list; with each subsequent survey other resources were selected more often than previously. • Approximately 15% of respondents in 2014 didn’t know where they’d send a person in need of mental health counseling; approximately 37% would recommend either the Person Counseling Center/Family Care Network or a doctor. • In 2014, 33.6% of respondents would refer to a private counselor or therapist and 31.5% would refer to a minister or religious official. Also in 2014 a higher percentage than on any previous survey would refer to a support group or school counselor. Considering all types of alcoholic beverages, how many times during the past 30 days did you have more than 5 alcoholic drinks on an occasion? (Q13; n=611) Alcohol 2014 # % 0 502 82.2 1-3 73 11.9 3-4 19 3.1 5 or more 17 2.8 • The majority of respondents (82.2%) reported never binge drinking (consuming more than 5 drinks in one day). That represented the lowest percentage of non-binge drinkers of any of the four most recent surveys. In 2003, 89% reported never consuming more than 5 drinks in day; the percentage decreased to 86.8% in 2007 and to 83.2% in 2011. (The survey-to-survey differences reported may not be statistically significant.) 207 APPENDIX 2 17 Do you use “e-cigarettes”? (Q14; n=606) E-cigarette use 2014 # % Yes 26 4.3 No 580 95.7  The vast majority of respondents (95.7%) do not use e-cigarettes. This is the first time this question has been asked on the Community Survey. The table below displays the 2014 response data for the “Do you smoke e-cigarettes?” question stratified by gender or race/ethnicity.  Male respondents report using e-cigarettes at a higher frequency (6%) than female respondents (4%).  African American respondents report using e-cigarettes at a higher frequency (7%) than whites (4%) or respondents of Hispanic origin (0%). Do you smoke regular (tobacco) cigarettes? Choose only one (1) answer. (Q15; n=609) Cigarette use 2003 2007 2011 2014 # % # % # % # % Not at all/I have never smoked cigarettes. 462 80.5 343 52.3 441 58.0 393 64.5 I used to smoke but have quit. n/a n/a 175 26.7 212 27.9 157 25.8 One pack or less a day 70 12.2 117 17.8 87 11.4 49 8.0 More than 1 pack a day 10 1.7 21 3.2 21 2.8 10 1.6 Rarely 16 2.8 n/a n/a n/a n/a n/a n/a Occasionally 16 2.8 n/a n/a n/a n/a n/a n/a  Approximately 65% of 2014 respondents reported having never smoked cigarettes, a higher percentage than in 2007 or 2011, but a lower percentage than in 2003.  Approximately 26% of 2014 respondents reported they used to smoke but have quit, a proportion similar to past survey responses.  Only 1.6% of respondents reported smoking more than one pack a day, the lowest percentage in any of the four most recent surveys.  Since the sum of 2014 respondents who never smoked and those who used to but quit totals approximately 90% of the respondents who answered the question (n=548), it may be deduced that the remaining approximate 10% of the respondents could be deemed “smokers” (n-61). # % # % # % # % # % Yes 9 6.4%17 3.8%16 3.6% 8 6.7% 0 0.0% No 131 93.6%435 96.2%434 96.4%112 93.3%30 100.0% Hispanic OriginMalesFemalesWhiteAfrican AmericanE-cigarette Use 208 APPENDIX 2 18 The table below displays the 2014 response data for the “Do you smoke regular cigarettes” question stratified by gender or race/ethnicity.  Female respondents reported never having been a smoker at a higher frequency (65%) than male respondents (56%).  Hispanic respondents reported never having been a smoker at higher frequency (83%) than whites (65%) or African Americans (55%).  African American respondents reported having quit smoking at a higher frequency (31%) than whites (26%) or Hispanics (13%). Where would you go for help if you wanted to quit smoking? Choose as many answers as you need to. (Q16; n=605) Tobacco Cessation 2007 2011 2014 # % # % # % I don’t smoke tobacco products. 303 45.2 n/a n/a 471 77.9 Doctor 61 9.1 50 46.3 50 8.3 Church 10 1.5 2 1.8 4 0.7 Pharmacy 14 2.1 7 6.5 28 4.6 Private Counselor/Therapist1 14 2.1 4 3.7 n/a n/a Quit Now NC 20 3.0 12 11.1 11 1.8 Health Department 16 2.4 3 2.8 13 2.1 Other 18 2.7 9 8.3 n/a n/a Not applicable; I don’t want to quit. 73 10.9 20 18.5 7 1.2 I don't know n/a n/a 23 21.3 51 8.4 1 Was combined with the Doctor option in 2014 • Based on the 2014 responses from those who currently smoke tobacco products, Doctor/private counselor/therapist was the predominant choice as a resource to help quitting, followed by pharmacy. • As noted previously, approximately 10% of respondents (n=61) could be deemed “smokers”. According to the data in the table above, seven respondents reported they did not want to quit smoking. These seven comprise approximately 11% of those who could be deemed smokers. • In 2007, the most common resource for help in quitting smoking was a doctor, followed by Quit Now NC. In that same survey, 10.9% of all respondents did not wish to quit smoking. In 2011, the most popular resource was a doctor, followed by Quit Now NC. That year 18.5% of all respondents did not want to quit smoking. # % # % # % # % # % I have never smoked.78 55.7%302 66.5%295 65.4%66 55.0%25 83.3% I used to smoke but have quit.50 35.7%106 23.3%116 25.7%37 30.8% 4 13.3% I smoke less than one pack a day.8 5.7%40 8.8%34 7.5%13 10.8% 1 3.3% I smoke one or more packs a day.4 2.9% 6 1.3% 6 1.3% 4 3.3% 0 0.0% Males Females White African American Hispanic OriginTobacco Cigarette Use 209 APPENDIX 2 19 Have you ever been told by a doctor, nurse, or other health professional that you have any of the conditions in the following list? Please answer every question. (Q17; n=611) Diagnoses 2007 2011 2014 # % # % # % Angina/heart disease n/a n/a 47 6.2 29 5.3 Asthma 84 12.8 85 11.1 n/a n/a Cancer n/a n/a 51 6.7 40 7.3 Depression 151 23.0 180 23.6 148 26.8 Diabetes (not during pregnancy) 86 13.1 91 12.0 88 15.8 High Blood Pressure 236 36.0 286 37.5 216 36.9 High Cholesterol 195 29.7 247 32.4 182 32.2 Lung disease n/a n/a n/a n/a 54 9.8 Overweight/Obesity 229 35.0 226 29.7 244 42.8 Osteoporosis 50 7.6 47 6.2 n/a n/a • Overweight/obesity was the most common diagnosis in 2014, reported by 42.8% of respondents. The next most common condition was high blood pressure, diagnosed among 36.9% of respondents. • In 2007, the most common diagnosis was high blood pressure, followed by overweight/obesity. In 2011, the most common diagnosis was high blood pressure, followed by high cholesterol. • The percentage of respondents who have been diagnosed with depression has increased each survey cycle and was reported by almost 27% of respondents in 2014. The table below displays the 2014 response data for the “Have you been diagnosed with…” question stratified by gender or race.  Among male respondents, the most frequently reported diagnosis was high blood pressure (43%), followed by high cholesterol (35%), and overweight/obesity (31%).  Among female respondents, the most frequently reported diagnosis was overweight/obesity (43%), followed by high blood pressure (33%), and high cholesterol (28%).  Among white respondents, the most frequently reported diagnosis was overweight/obesity (39%), followed by high blood pressure (31%), and depression/anxiety (28%).  Among African Americans, the most frequently reported diagnosis was high blood pressure (53%), followed by high cholesterol (46%), and overweight/obesity (45%). # % # % # % # % # % Angina/heart disease 12 8.6%15 3.3%20 4.4% 6 5.0% 1 3.3% Cancer 12 8.6%27 5.9%29 6.4% 9 7.5% 2 6.7% Depression or anxiety 22 15.7%122 26.8%127 28.0%17 14.2% 3 10.0% Diabetes (not during pregnancy)21 15.0%65 14.3%50 11.0%34 28.3% 1 3.3% High blood pressure 60 42.9%152 33.3%141 31.1%64 53.3% 4 13.3% High cholesterol 49 35.0%129 28.3%119 26.3%55 45.8% 3 10.0% Lung disease 11 7.9%41 9.0%41 9.1% 9 7.5% 0 0.0% Overweight/obesity 43 30.7%197 43.2%178 39.3%54 45.0%10 33.3% Hispanic OriginMalesFemalesWhiteAfrican AmericanDiagnoses 210 APPENDIX 2 20  Among respondents of Hispanic origin, the most frequently reported diagnosis was overweight/obesity (33%), followed by high blood pressure (13%), and high cholesterol and depression/anxiety (each 10%). If you are a male, do you conduct regular testicular self-exams? (Q18; n=153) Testicular Self-Exams 2011 2014 # % # % Yes 125 54.6 63 41.2 No 104 45.4 75 49.0 Don't know/not sure n/a n/a 15 9.8  In 2014, 41.2% of the males participating report conducting regular testicular self-exams, down from 54.6% in 2011. Please note that between the 2011 and the 2014 Person County Community Health Surveys the recommendations for the appropriate ages and frequency of screenings have changed for several types of cancer screenings, so results from the two surveys are not directly comparable. If you are a male age 50 or older, do you have a prostate exam (e.g., PSA blood test or digital rectal exam) as frequently as recommended by a doctor or other health care provider? (If you are a female, or a male under age 50, skip this question.) (Q19; n=112) Prostate Exams 2014 # % Yes 90 80.4 No 14 12.5 Not Sure/Don't Know 8 7.1 • In 2014 approximately 80% of male respondents of the appropriate age reported having prostate exams as recommended. In 2007 and 2011, 64.5% and 69.4%, respectively, of appropriately aged males reported having prostate exams as recommended. If you are a female, do you conduct regular breast self-exams? (Q20; n=460) Breast Self-Exams 2011 2014 # % # % Yes 381 70.8 270 58.7 No 157 29.2 178 38.7 Don't know/Not sure n/a n/a 12 2.6 • In 2014 approximately 59% of the females who answered this question reported they conducted regular breast self-exams, a decrease from approximately 71% in 2011. 211 APPENDIX 2 21 If you are female age 40 or over, do you have an annual mammogram (breast x-ray)? (Q21; n=323) Annual Mammogram 2007 2011 2014 # % # % # % Yes 242 78.6 282 77.3 270 58.7 No 60 19.5 83 22.7 178 38.7 Not Sure/Don't Know 6 1.9 0 0.0 12 2.6 • In 2014 approximately 59% of appropriately aged females reported having an annual mammogram, a significant decrease from 2007 and 2011 responses of approximately 78%. If you are a female age 21 or older, do you have a Pap smear as frequently as recommended by a doctor or other health care provider? (Q22; n=453) Pap Test 2007 2011 2014 # % # % # % Yes 397 84.5 399 79.5 373 82.3 No 70 14.9 103 20.5 73 16.1 Not Sure/Don't Know 3 0.6 0 0.0 7 1.5  The majority of female respondents usually have a Pap smear as frequently as recommended. In 2014, 82.3% of appropriately aged females reported having Pap tests performed as frequently as recommended. If you are a male or female age 50 or older, have you ever had a colon cancer screening (e.g., fecal occult blood test, sigmoidoscopy, or colonoscopy)? (Q23; n=320) Colon Cancer Screening 2007 2011 2014 # % # % # % Yes 190 62.3 264 69.7 230 71.9 No 106 34.8 115 30.3 81 25.3 Not Sure/Don't Know 9 3.0 0 0.0 9 2.8  The percentage of survey respondents over the age of 50 who reported having been screened for colon cancer has increased with each survey cycle. In 2014, approximately 72% of appropriately aged respondents reported having been screened for colon cancer. 212 APPENDIX 2 22 All males and females, do you conduct monthly skin self-checks (for moles, skin changes, etc.)? (Q24; n=607) Skin Self-Checks 2011 2014 # % # % Yes 570 75.3 387 63.8 No 187 24.7 209 34.4 Don't know/Not sure n/a n/a 11 1.8 • Approximately 64% of respondents reported conducting regular skin self-checks, a decrease from approximately 75% in 2011. Emergency Preparedness Does your household have working smoke and carbon monoxide detectors? (Q25; n=607) Smoke and Carbon Monoxide Detectors 2011 2014 # % # % Smoke detectors only 416 54.0 356 58.6 Carbon monoxide detectors only 8 1.0 7 1.2 Both smoke and carbon monoxide detectors 288 37.4 219 36.1 Neither 45 5.8 n/a n/a Don't know/not sure 14 1.7 25 4.1  Nearly 59% of 2014 respondents reported having only smoke detectors in their household, a slightly greater percentage than in 2011.  Approximately 36% of respondents report having both smoke and carbon monoxide detectors, a slight decrease from 2011. Does your family have a basic emergency supply kit with enough supplies to last at least three (3) days? (Q26; n=608) Emergency Supply Kit 2014 # % Yes 232 38.2 No 359 59.0 Don't know/not sure 17 2.8  Approximately 38% of 2014 respondents reported having a basic emergency kit that can last at least three days.  In 2011, this question inquired whether or not a family had a basic emergency supply kit; the number of days that supply kit could cover was a separate question. In 2011, 38.3% of respondents reported having a basic emergency supply kit; among those with kits, 70.4% said their supplies would last for more than 4 days. 213 APPENDIX 2 23 What would be your main way of getting information from authorities in a large-scale disaster or emergency? (Please mark only one choice). (Q27; n=597) Source of Information in Emergency 2011 2014 # % # % Television 504 65.0 229 38.4 Radio 106 13.7 80 13.4 Internet 48 6.2 39 6.5 Print media (newspaper) 8 1.0 1 0.2 Social networking site 9 1.2 17 2.8 Neighbors, Friends, Family1 10 1.3 22 3.7 Text message (emergency alert system) 37 4.8 188 31.5 Other 20 2.6 n/a n/a Don't know/not sure 33 4.3 21 3.5 1 In 2011 this option was only listed as Neighbors • In 2011, 65.0% of respondents reported they would get information about a disaster or emergency via television. That percentage dropped to 38.4% in 2014. Also in 2014 the text message emergency alert system was the next most common source of information in an emergency or disaster (31.5%, up from 4.8% in 2011). • In both the 2011 and 2014 survey cycles, approximately 13% of respondents would turn to the radio for emergency information. If public authorities announced a mandatory evacuation from your neighborhood or community due to a large-scale disaster or emergency, would you voluntarily evacuate? (Q28; n=605) Evacuation 2011 2014 # % # % Yes 629 81.5 487 80.5 No 34 4.4 7 1.2 Don't know/not sure 109 14.1 111 18.3 • Approximately 81% of respondents to both the 2011 and 2014 surveys reported that they would voluntarily evacuate their community during a large disaster or emergency. • Approximately 18% of respondents did not know what they would do in such a situation, an increase from 14% 2011. 214 APPENDIX 2 24 If you answered “Not sure/don’t know” or “No”, why are you unsure or why would you not evacuate? (Choose as many reasons as you need to.) (Q29; n=283) Reason for Not Evacuating 2011 2014 # % # % Lack of transportation 15 5.9 4 1.4 Lack of trust in public officials 16 6.3 20 7.1 Concern about leaving property behind 1 0.4 69 24.4 Concern about personal safety 16 6.3 45 15.9 Concern about family safety 41 16.2 47 16.6 Concern about leaving pets 29 11.5 50 17.7 Concern about traffic jams and ability to leave 16 6.3 19 6.7 Health problems (could not be moved) 7 2.8 3 1.1 Other 17 6.7 20 7.1 Don't know/not sure 44 17.4 n/a n/a Not applicable: I said I would evacuate n/a n/a 162 57.2 • In 2014, the primary reason reported for not evacuating was concern about leaving property behind (24.4%), followed by concern about leaving pets behind (17.7%). • In 2011, the primary reason for not evacuating was concern about family safety (16.2%) although a slightly larger proportion (17.4%) didn’t know or was not sure why they would not evacuate. Are you signed up to receive local emergency alerts through the “Code Red” system? (Q30; n=608) Code Red Participation 2014 # % Yes 246 40.5 No; I’ve heard about “Code Red” but haven’t signed up yet. 91 15.0 No; I don’t know what “Code Red” is. 203 33.4 No; I don’t know how to sign up 52 8.6 No; I prefer not to sign up 16 2.6  Approximately 40% of 2014 respondents reported they were currently signed up to receive local alerts through the Code Red system.  One-third of the 2014 participants reported they did not know what the Code Red system was. 215 APPENDIX 2 25 Health Department Questions These questions were new on the 2014 Survey. Are you familiar with the services provided by the Person County Health Department (includes services through Home Health and Hospice of Person County, and Environmental Health)? (Q31; n=603) Familiar with Health Department # % Yes 398 66.0 No 205 34.0  Two-thirds of the respondents reported they were familiar with the services provided by the Person County Health Department. Which of the following Person County Health Department services have you ever used? (Choose as many answers as you need to.) (Q32; n=592) Services Used # % I have not used any health department services 220 37.2 Clinical Services 276 46.6 WIC (Women, Infants, Children) Nutrition Services 79 13.3 Environmental Health Services 109 18.4 Home Health and Hospice Services 69 11.7 Health Education Services 62 10.5 Other 14 2.4  The most commonly used service reported by survey participants was clinical services, which include shots, worksite flu clinics, blood pressure checks, lab work, birth control, prenatal visits, STD testing/treatment, child health visits, breast and cervical cancer control visits, etc. Nearly 47% of 2014 respondents had used clinical services at the Person County Health Department.  Approximately 37% of respondents had not used any services offered by the health department. Person County Health Department’s main building, which houses all services except Environmental Health, is open Monday-Friday from 8:00 a.m. to 4:30 p.m. Are these hours sufficient to meet the needs of the community? (Q33; n=600) Sufficient Health Department Hours # % Yes 276 46.0 No 51 8.5 Maybe there needs to be extended hours one evening a week 273 45.5 216 APPENDIX 2 26  Approximately 46% of respondents felt that the health department’s hours were sufficient, and another 46% thought perhaps there should be extended hours one evening a week. Environmental Health offices are open Monday-Friday from 8:30 a.m. to 5:00 p.m. Are these hours sufficient to meet the needs of the community? (Q34; n=596) Sufficient Environmental Health Hours # % Yes 516 86.6 No 80 13.4  The large majority (approximately 87%) of survey respondents felt that the Environmental Health office hours were sufficient. 217 APPENDIX 2 27 2014 Person County Community Health Survey (English) The purpose of this survey is to learn more about the health and quality of life in Person County. Various local health agencies will use the results of this survey to help them to develop plans for addressing the major health issues. Your answers will not be linked to you in any way. Thank you for taking the time to complete this Community Health Survey. PLEASE READ THIS IMPORTANT MESSAGE DO NOT complete the survey (1) if you live outside Person County, or (2) you are not at least 18 years old, or (3) if you have already completed this survey. --------------------------------------------------------------------------------------------------------------------- PART 1: Community Problems and Issues The next three questions ask your opinion about the most important heath, behavioral and social problems and issues in Person County. 1. Health Problems Using the following list please put a check mark next to the five (5) most important health problems in Person County. (Problems that you think have the greatest overall effect on health in the community.) Remember to check only FIVE (5): ___ Accidental injuries NOT involving vehicles (e.g., falls, choking, drowning, poisoning, gun accidents, etc.) ___ Alzheimer’s disease ___ Cancer ___ Dental health ___ Diabetes ___ Heart disease/heart attack ___ HIV/AIDS ___ Infant death ___ Infectious/contagious diseases (e.g., tuberculosis, flu, pneumonia, food poisoning, etc.) ___ Kidney disease ___ Liver Disease ___ Lung disease (asthma emphysema, COPD, chronic bronchitis) ___ Mental health (depression, schizophrenia, etc.) ___ Motor vehicle accident injuries ___ Obesity/overweight ___ Sexually transmitted diseases (e.g., chlamydia, gonorrhea) ___ Stroke ___ Substance abuse (incl. alcohol, prescription drugs, illegal drugs, tobacco, etc.) ___ Teenage pregnancy ___ Other 218 APPENDIX 2 28 2. Unhealthy Behaviors Using the following list please put a check mark next to the five (5) most important unhealthy behaviors in Person County. (Unhealthy behaviors that you think have the greatest overall effect on health and safety in the community.) Remember to check only FIVE (5): ___ Alcohol abuse ___ Drug abuse (incl. prescription drugs and illegal drugs) ___ Having unsafe sex ___ Lack of exercise/poor physical fitness ___ Lack of parenting skills ___ Not getting immunizations (“shots”) to prevent disease ___ Not using child safety seats ___ Not using seatbelts ___ Not going to a dentist for preventive checkups and cleaning ___ Not going to the doctor for preventive check-ups and screenings ___ Not getting prenatal (pregnancy) care ___ Poor eating habits ___ Poor preparation for disasters and emergencies ___ Reckless/drunk driving ___ Smoking/tobacco use ___ Suicide ___ Violent, angry behavior 3. Community Issues Using the following list please put a check mark next to the five (5) most important community- wide issues in Person County. (Social issues that you think have the greatest overall effect on the quality of life in the community.) Remember to check only FIVE (5): ___ Animal control issues/rabies ___ Availability of child care ___ Affordability of health services ___ Affordability of housing ___ Availability of healthy food choices in restaurants and grocery stores ___ Crime (e.g., theft, murder, assault, etc.) ___ Disaster preparedness (plans for natural disaster, bioterrorism, pandemic flu, etc.) ___ Dropping out of school ___ Gang activity ___ Homelessness ___ Lack of/inadequate health insurance ___ Lack of culturally appropriate services for minorities ___ Lack of counseling/mental health services/support groups ___ Lack of healthcare providers ___ Lack of recreational facilities (e.g., parks, trails, community centers, etc.) ___ Low income/poverty ___ Neglect and abuse ___ Pollution (air, water, land) ___ Racism/discrimination ___ Transportation options ___ Unemployment/underemployment ___ Unsafe/unmaintained roads ___ Unsafe schools (e.g., in/at-school crime, violence, bullying, etc.) 219 APPENDIX 2 29 PART 2: Health Care Access The following questions ask about how you access health care. Remember, this survey will not be linked to you in any way. 4. Where do you get most of your health-related information or advice? Choose only one (1) answer. ___ Friends and family ___ Help lines ___ Church ___ Doctor/nurse ___ Newspaper/magazine/TV ___ Internet ___ Health Department ___ Pharmacist ___ Other ___ Hospital ___ School 5. Where do you go most often when you are sick? Choose only one (1) answer. ___ Doctor's office ___ Person Family Medical and Dental Centers, Inc. ___ Health Department ___ Other ___ Hospital emergency department ___ I don’t usually get care when I’m sick ___ Urgent Care Center 6. Is this place you go when you are sick in Person County? ___ Yes ___ No 7. About how long has it been since you last visited a doctor for a routine checkup? (Do NOT include any times you visited the doctor because you were sick or pregnant.) Choose only one (1) answer. ___ Within the past year ___ 5 or more years ago ___ 1-2 years ago ___ I have never had a routine checkup. ___ 3-5 years ago 8. Was there a time in the past 12 months when you needed medical care but could not get it? ___ No ___ Yes, because I didn’t have health insurance and couldn’t afford the cost by myself. ___ Yes, because I had health insurance but it didn’t cover what I needed. ___ Yes, because I had health insurance but my share of the cost (deductible/co-pay/co-insurance) was too high. ___ Yes, because the provider (doctor, clinic or hospital) would not take my insurance or Medicaid. ___ Yes, because I didn’t have transportation to get there. ___ Yes, because I didn’t know where to go. ___ Yes, because it took too long to get an appointment. ___ Yes, because the doctor wasn’t taking new patients. 220 APPENDIX 2 30 9. Was there a time in the past 12 months when you could not get a medically necessary prescription? ___ No ___ Yes, because I didn’t have health insurance and couldn’t afford the cost by myself. ___ Yes, because I had health insurance but it didn’t cover any prescriptions or the prescription I needed. ___ Yes, because I had health insurance drug coverage but my share of the cost (deductible/co-pay/co- insurance) was too high. ___ Yes, because the pharmacy would not take my insurance or Medicaid. ___ Yes, because I had problems with Medicare Part D coverage. ___ Yes, because I didn’t have transportation to get there. ___ Yes, because I didn’t know where to go. 10. About how long has it been since you last visited a dentist for a routine checkup? (Do NOT include times you visited the dentist because of an emergency.) Choose only one (1) answer. ___ Within the past year ___ 5 or more years ago ___ 1-2 years ago ___ I have never been to a dentist for a routine checkup. ___ 3-5 years ago 11. Was there a time during the past 12 months when you needed to get dental care but could not? ___ No ___ Yes, because I didn’t have dental insurance and couldn’t afford the cost by myself. ___ Yes, because I had dental insurance but it didn’t cover what I needed. ___ Yes, because I had dental insurance but my share of the cost (deductible/co-pay/co-insurance) was too high. ___ Yes, because the dentist would not take my insurance or Medicaid. ___ Yes, because I didn’t have transportation to get there. ___ Yes, because I didn’t know where to go. ___ Yes, because It took too long to get an appointment. ___ Yes, because the dentist wasn’t taking new patients. 12. If a friend or family member needed counseling for a mental health or a drug/alcohol abuse problem, who would you tell them to call or talk to? Choose as many answers as you need to. ___ Person Counseling Center/Freedom House Recovery ___ School counselor, nurse or social worker ___ Private counselor or therapist ___ Support group (e.g., AA, Al-Anon) ___ Doctor ___ Other ___ Minister/religious official ___ Not sure/don’t know ___ Person Memorial Hospital 221 APPENDIX 2 31 PART 3. Personal Health The following questions ask about your own personal health. Remember, this survey will not be linked to you in any way. 13. Considering all types of alcoholic beverages, on how many days during the past month did you have 5 or more alcoholic drinks on a single occasion or at one sitting? Choose only one (1) answer. ___ None ___ One or two times ___ Three or four times ___ Five or more times 14. Do you use “e-cigarettes”? ___ Yes ___ No 15. Do you smoke regular (tobacco) cigarettes? Choose only one (1) answer. ___ I have never smoked. ___ I used to smoke but have quit. ___ I smoke less than one pack a day. ___ I smoke one or more packs a day. 16. Where would you go for help if you wanted to quit smoking? Choose as many answers as you need to. ___ Not applicable: I don’t smoke ___ Pharmacy/over-the-counter product ___ Not applicable: I don’t want to quit smoking ___ Church/religious leader ___ Quit Now NC/Quit Line ___ Doctor, private counselor/therapist ___ Health Department ___ Not sure/don’t know 17. Have you ever been told by a doctor, nurse, or other health professional that you have any of the conditions in the following list? Please answer every question. Angina/heart disease ___ Yes ___ No Lung disease (asthma, COPD, chronic bronchitis) ___ Yes ___ No Cancer ___ Yes ___ No Depression or anxiety ___ Yes ___ No Diabetes (not during pregnancy) ___ Yes ___ No High blood pressure ___ Yes ___ No High cholesterol ___ Yes ___ No Overweight/obesity ___ Yes ___ No 18. If you are a male, do you conduct monthly testicular self-exams? (If you are a female, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 222 APPENDIX 2 32 19. If you are a male age 50 or older, do you have a prostate exam (e.g., PSA blood test or digital rectal exam) as frequently as recommended by a doctor or other health care provider? (If you are a female, or a male under age 50, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 20. If you are a female, do you conduct monthly breast self-exams? (If you are a male, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 21. If you are a female age 40 or older, do you have an annual mammogram (breast x-ray)? (If you are a male, or a female under age 40, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 22. If you are a female age 21 or older, do you have a Pap smear as frequently as recommended by a doctor or other health care provider? (If you are a male, or a female under age 21, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 23. If you are a male or female age 50 or older, have you ever had a colon cancer screening (e.g., fecal occult blood test, sigmoidoscopy, or colonoscopy)? (If you are under age 50, skip this question.) ___ Yes ___ No ___ Not sure/don’t know 24. All males and females: Do you conduct monthly skin self-checks (for moles, skin changes, etc.)? ___ Yes ___ No ___ Not sure/don’t know Part 4. Emergency Preparedness 25. Does your household have working smoke and carbon monoxide detectors? (Choose only one (1) answer.) ___ Yes, smoke detectors only ___ Yes, both kinds of detectors ___ Yes, carbon monoxide detectors only ___ Not sure/don’t know 26. Does your family have a basic emergency supply kit with enough supplies to last at least three (3) days? (These kits include water, non-perishable food, necessary prescriptions, first aid supplies, flashlight and batteries, non-electric can opener, blanket, etc.). ___ Yes ___ No ___ Not sure/don’t know 223 APPENDIX 2 33 27. What would be your main way of getting information from authorities in a large-scale disaster or emergency? (Choose only one (1) answer.) ___ Television ___ Print media (newspaper) ___ Text message or phone call from an ___ Radio ___ Social networking site emergency alert system ___ Internet ___ Neighbors, friends, family ___ /Not sure/don’t know 28. If public authorities announced a mandatory evacuation from your neighborhood or community due to a large-scale disaster or emergency, would you voluntarily evacuate? ___ Yes, I would evacuate ___ Not sure/don’t know if I would evacuate ___ No, I would not evacuate 29. If you answered “Not sure/don’t know” or “No”, why are you unsure or why would you not evacuate? (Choose as many reasons as you need to): ___ Not applicable: I said I would evacuate ___ Concern about family safety ___ Lack of transportation ___ Concern about leaving pets ___ Lack of trust in public officials ___ Concern about traffic jams/ability to leave ___ Concern about leaving property behind ___ Health problems (could not be moved) ___ Concern about personal safety ___ Other 30. Are you signed up to receive local emergency alerts through the “Code Red” system? Choose only one (1) answer. ___ Yes ___ No; I’ve heard about “Code Red” but haven’t signed up yet. ___ No; I don’t know what “Code Red” is. ___ No; I don’t know how to sign up ___ No; I prefer not to sign up Part 5. Health Department Questions 31. Are you familiar with the services provided by the Person County Health Department (includes services through Home Health and Hospice of Person County, and Environmental Health)? ___ Yes ___ No 224 APPENDIX 2 34 32. Which of the following Person County Health Department services have you ever used? (Choose as many answers as you need to.) ___ I have not used any health department services ___ Clinical Services (e.g., shots, worksite flu clinics, blood pressure checks, lab work, birth control, prenatal visits, STD testing/treatment, child health visits, breast and cervical cancer control visits, etc.) ___ WIC (Women, Infants, Children) Nutrition Services ___ Environmental Health Services (e.g., restaurant inspections, well water sampling, septic system permits, etc.) ___ Home Health and Hospice Services ___Health Education Services (e.g., educational programs, weight loss challenges, chronic disease and diabetes self-management programs, etc.) ___ Other 33. Person County Health Department’s main building, which houses all services except Environmental Health, is open Monday-Friday from 8:00 a.m. to 4:30 p.m. Are these hours sufficient to meet the needs of the community? (Choose only one (1) answer.) ___ Yes ___ No ___ Maybe there needs to be extended hours one evening a week 34. Environmental Health offices are open Monday-Friday from 8:30 a.m. to 5:00 p.m. Are these hours sufficient to meet the needs of the community? (Choose only one (1) answer.) ___ Yes ___ No The health department welcomes your comments and suggestions. Go to: http://health.personcounty.net (Questions and Comment Link), call 336-597-2204 x2278 (Comment Line) or call 336-597-2204. There is also Public Comment time at Board of Health meetings (4th Monday of each month at 7:00 p.m.) FINAL PART. Demographic Questions We have a final set of questions about you. These are questions that help us understand how different types of people view different health issues. 35. What is the ZIP code of your PRIMARY residence in Person County? Check only one (1). ___ 27291 ___ 27343 ___ 27565 ___ 27573 ___ 27583 ___ 27305 ___ 27541 ___ 27572 ___ 27574 ___ Other 36. How old are you? ___ 18-19 ___ 40-49 ___ 65-69 ___ 85 or older ___ 20-29 ___ 50-59 ___ 70-79 ___ 30-39 ___ 60-64 ___ 80-85 225 APPENDIX 2 35 37. Are you male or female? ____ Male ____ Female 38. Are you of Hispanic, Latino, or Spanish origin? ___ Yes ___ No 39. What do you consider your race? Please check only one (1) answer. ___ White only ___ Black/African American only ___ Native American/American Indian/Alaska Native only ___ Asian (Indian, Pakistani, Japanese, Chinese, Korean, Vietnamese, Filipino/a) only ___ Pacific Islander (Native Hawaiian, Samoan, Guamanian/Chamorro) only ___ Other race not listed here ___ Two or more races 40. What is the highest level of school, college or training that you have finished? Choose only one (1) answer. ___ Less than 9th grade ___ Some college (no degree) ___ 9th – 12th grade, no diploma ___ Bachelor’s degree ___ High school diploma (or GED/equivalent) ___ Graduate or professional degree ___ Associate’s Degree or Vocational Training ___ Other 41. What was your total household income last year, before taxes? (This includes everybody age 15 or older who lives in your house and has income.) Choose only one (1) answer. ___ Less than $20,000 ___ $40,000 to $49,999 ___ $70,000 to $79,000 ___ $20,000 to $29,999 ___ $50,000 to $59,999 ___ $80,000 to $99,000 ___ $30,000 to $39,999 ___ $60,000 to $69,000 ___ $100,000 or more 42. 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.) Choose only one (1) answer. ___ 1 person ___ 2 people ___ 3 or 4 people ___ 5 or more people 43. What is your employment status? (Choose as many answers as you need to describe your situation.) ___ Employed full-time ___ Unemployed ___ Homemaker ___ Employed part-time ___ Disabled ___ Self-employed ___ Retired ___ Student 44. Do you have any kind of medical health insurance coverage? ____ Yes ____ No 226 APPENDIX 2 36 45. Does your medical health insurance cover prescription drugs? ____ Yes ____ No 46. Do you use the Internet? ____ Yes ____ No Thank you very much for completing the Community Health Survey! 227 APPENDIX 2 37 2014 Person County Community Health Survey (Spanish) ENCUESTA DE SALUD DE LA COMUNIDAD DEL CONDADO DE PERSON El propósito de esta encuesta es conocer más acerca de la salud y calidad de vida en el Condado de Person. Una variedad de agencias locales de salud utilizarán los resultados de esta encuesta para desarrollar planes encaminados para atender los problemas principales de salud de dicho Condado. Las respuestas que proporcione en esta encuesta no serán vinculadas con usted de ninguna manera. Gracias por su tiempo en completar esta Encuesta de Salud Comunitaria. POR FAVOR LEA ESTE MENSAJE IMPORTANTE NO Complete esta encuesta (1) si usted vive afuera del Condado de Person, o (2) usted es menor de 18 años, o (3) si usted ya completó esta encuesta. ----------------------------------------------------------------------------------------------------------------------------- PARTE 1: PROBLEMAS Y ASPECTOS DE LA COMUNIDAD En las siguientes tres preguntas le pedimos su opinión acerca de los aspectos relacionados con la salud, el comportamiento y los problemas sociales en el Condado de Person. 1. Problemas de Salud Utilizando la siguiente lista, por favor ponga una X junto a los cinco (5) problemas de salud de mayor importancia en el Condado de Person. (Problemas que en su opinión tienen mayor efecto sobre la comunidad en general) Recuerde marcar solo cinco (5): ___ Lesiones accidentales que NO involucra vehículos (caídas, atragantarse, ahogarse, envenenamiento, accidentes relacionados con armas, etc.) ___ Enfermedad de Alzheimer ___ Cáncer ___ Salud Dental ___ Diabetes ___ Enfermedades del corazón/ ataques al corazón ___ VIH/SIDA ___ Muerte Infantil ___ Enfermedades infecto- contagiosas (Tuberculosis, gripe, neumonía, envenenamiento por comida, etc.) ___ Enfermedades del riñón ___ Enfermedades del hígado ___ Enfermedades del pulmón (asma, enfisema, COPD, bronquitis crónica) bronquitis crónica) ___ Salud mental (depresión, esquizofrenia, etc.) ___ Lesiones por accidente en un vehículo motorizado ___ Obesidad/sobrepeso ___ Enfermedades de Transmisión Sexual (clamidia, gonorrea) ___ Ataque de apoplejía (Embolia) ___ Abuso de sustancias (incluyendo alcohol, drogas con prescripción, drogas ilegales, tabaco, etc.) ___ Embarazo adolescente ___ Otro 228 APPENDIX 2 38 2. Comportamientos poco Saludables Utilizando la siguiente lista, por favor ponga una X junto a los cinco (5) comportamientos poco saludables de mayor importancia en el Condado de Person. (Comportamientos que en su opinión tienen mayor efecto sobre la salud y seguridad de la comunidad en general) Recuerde marcar solo cinco (5): ___ Abuso de alcohol ___ Abuso de drogas (incluyendo drogas con prescripción y drogas ilegales) ___ Tener sexo sin protección ___ Falta de hacer ejercicio/centro físico ___ Falta de técnicas para ser padres ___ No recibir imunizaciones (“vacunas”) para prevenir las enfermedades ___ No utilizar los asientos de seguridad para niños ___ No utilizar los cinturones de seguridad ___ No visitar al dentista para los chequeos preventivos y limpieza ___ No ir al médico para los chequeos y exámenes preventivos ___ No obtener cuidado prenatal (durante el embarazo) ___ Malos hábitos alimenticios ___ Mala preparación para desastres y emergencias ___ Conducir imprudente- mente/ebrio ___ Fumar/utilizar tabaco ___ Suicidio ___ Violencia, comportamiento violento 3. Aspectos de la Comunidad Utilizando la siguiente lista, por favor ponga una X junto a los cinco (5) problemas comunitarios de mayor importancia en el Condado de Person. (Aspectos sociales que en su opinión tienen mayor efecto en la calidad de vida de la comunidad en general.) Recuerde marcar solo cinco (5): ___ Problemas de control animal/hidrofobia ___ Disponibilidad de guarderías ___ Accesibilidad a los servicios de salud ___ Accesibilidad para vivienda ___ Disponibilidad de opciones para obtener alimentos saludables en restaurantes/tiendas ___ Crimen (robo, asesinato, asalto, etc.) ___ Preparación para desastres (planeación para desastres naturales, bioterrorismo, gripe epidémica, etc.) ___ Abandono de la escuela ___ La actividad de las pandillas ___ Personas sin un hogar ___ Falta de/inadecuado seguro médico ___ Falta de servicios culturales para las minorías ___ Falta de consejeros/servicios de salud mental/grupos de apoyo ___ Falta de proveedores para el cuidado de salud ___ Falta de instalaciones recreativas (parques, senderos, centros comunitarios, etc.) ___ Bajos ingresos/pobreza ___ Abandono y abuso (especifique el tipo) ___ Contaminación (aire, agua, tierra) ___ Racismo/Discriminación ___ Opciones de transporte ___ Desempleo/bajoempleo ___ Carreteras inseguras/sin mantenimiento ___ Escuelas inseguras (crimen en la/dentro de la escuela, violencia, acoso, etc.) 229 APPENDIX 2 39 PARTE 2: ACCESO PARA EL CUIDADO DE SALUD Las siguientes preguntas se refieren a su salud personal y a las opciones de salud. Recuerde, esta encuesta no será vinculada con usted de ninguna manera. 4. ¿Dónde obtiene la mayoría de información relacionada con la salud? Por favor escoja solo una (1) respuesta. ___ Amigos y familia ___ Líneas de ayuda ___ Iglesia ___ Doctor/enfermera ___ Periódicos/revistas/TV ___ Internet ___ Departamento de Salud ___ Farmaceuta ___ Otro: ______________ ___ Hospital ___ Escuela 5. ¿A dónde se dirige con mayor frecuencia cuando usted está enfermo? Por favor escoja solo una (1) respuesta. ___ La oficina del doctor ___ Centro Familiar Médico y Dental de Person, Inc. ___ Departamento de Salud ___ Otro ___ Departamento de Emergencia del Hospital ___ Yo usualmente no recibo cuidado medico cuando ___ Centro de Cuidado de Urgencias estoy enfermo/a 6. ¿El lugar a donde usted vá cuando está enfermo/a está dentro del Condado de Person? _Si _No 7. ¿Cuánto tiempo ha pasado desde la última vez que visitó al doctor para una revisión de rutina? (NO incluya las veces que lo visitó por estar enfermo/a o embarazada) Por favor escoja solo una (1) respuesta. ___ Dentro del año que pasó ___ 5 o más años atrás ___ 1-2 años atrás ___ Nunca he tenido una revisión médica de rutina. ___ 3-5 años atrás 8. ¿Hubo algún momento en los últimos 12 meses en el que usted necesitó cuidado médico, pero no lo pudo obtener? Puede marcar más de una respuesta. ___ No ___ Si, porque yo no tenía seguro médico y no podía pagar el costo por mi cuenta ___ Si, porque mi seguro médico no cubría los que necesitaba ___ Si, porque mi parte del costo (deducible/co-pago) del seguro médico es muy alta ___ Si, porque el proveedor (doctor, clínica u hospital) no aceptó mi seguro médico o Medicaid ___ Si, porque yo no tuve transporte ___ Si, porque yo no sabía a donde dirigirme ___ Si, porque tomó mucho tiempo para poder conseguir una cita ___ Si, porque el doctor no estaba aceptando pacientes nuevos 9. ¿Hubo algún momento en los últimos 12 meses en el que usted no pudo obtener una prescripción médica necesaria? Puede marcar más de una respuesta. ___ No ___ Si, porque yo no tenía seguro médico y no podía pagar el costo por mi cuenta ___ Si, porque mi seguro médico no cubre prescripciones o la prescripción que yo necesitaba ___ Si, porque mi parte del costo (deducible/co-pago) del seguro médico es muy alta ___ Si, porque la farmacia no aceptó mi seguro médico o Medicaid ___ Si, porque yo tuve problemas con la cobertura parte D del Medicare ___ Si, porque yo no tuve transporte ___ Si, porque yo no sabía a donde dirigirme 230 APPENDIX 2 40 10. ¿Aproximadamente cuánto tiempo ha pasado desde la última vez que visitó al dentista para una revisión de rutina? (No incluya las veces que lo visitó debido a una emergencia) Por favor escoja solo una (1) respuesta. ___ Dentro del año que pasó ___ 5 o más años atrás ___ 1-2 años atrás ___ Nunca me he realizado una revisión de rutina con el dentista ___ 3-5 años atrás 11. ¿Hubo algún momento en los últimos 12 meses en el que usted necesitó cuidado dental, pero no pudo obtenerlo? Puede marcar más de una respuesta. ___ No ___ Si, porque yo no tenía seguro médico dental y no podía pagar el costo por mi cuenta ___ Si, porque mi seguro médico dental no cubría lo que necesitaba ___ Si, porque mi parte del costo (deducible/co-pago) del seguro médico dental es muy alta ___ Si, porque el dentista no aceptó mi seguro médico dental o Medicaid ___ Si, porque yo no tuve transporte ___ Si, porque yo no sabía a donde dirigirme ___ Si, porque tomó mucho tiempo para poder conseguir una cita ___ Si, porque el dentista no estaba aceptando pacientes nuevos 12. Si un amigo o miembro de su familia necesita asesoría para un problema de salud mental o de abuso de drogas alcohol, ¿A quién le recomendaría que llame o visite? Puede marcar más de una respuesta ___ Centro de Asesoría de Person/Hogar de Recuperación Freedom ___ Consejero privado o terapeuta ___ Consejero Escolar, Enfermera, Trabajador Social ___ Doctor ___ Grupo de apoyo (A.A. Al-Anón) ___ Ministro/representante religioso ___ Otro ___ Hospital Memorial de Person ___ Yo no sé/no estoy seguro(a) PARTE 3: SALUD PERSONAL Las siguientes preguntas se refieren a su propia salud personal. Recuerde, esta encuesta no será vinculada con usted de ninguna manera. 13. Considerando todo tipo de bebidas alcohólicas, ¿Cuántos días durante el último mes, usted consumió 5 o más bebidas alcohólicas en una ocasión? Por favor escoja solo una respuesta. ___ Ninguna ___ Una o dos veces ___ tres o cuatro veces ___ Cinco o mas veces 14. ¿Usted utiliza los cigarrillos-electrónicos? _Si _No 15. ¿Usted fuma regularmente(tabaco) cigarillo? Por favor escoja solo una (1) respuesta. ___ Yo nunca he fumado ___ Yo fumaba, pero lo dejé ___ Yo fumo menos de un paquete al día ___ Yo fumo uno o más paquetes al día 231 APPENDIX 2 41 16. ¿A dónde se dirigiría usted si quisiera ayuda para dejar de fumar? Puede marcar más de una respuesta. ___ No aplica; yo no fumo ___ Farmacia/producto sobre el mostrador ___ No aplica; yo no quiero dejarlo ___ Iglesia/Líder religioso ___ Dejarlo Ahora CN (Quit Now NC) ___ Doctor, consejero privado/terapista ___ Departamento de Salud ___ No estoy seguro(a)/yo no sé 17. ¿Alguna vez le ha dicho un doctor, enfermera u otro profesional de la salud que usted tiene alguna de las siguientes condiciones médicas? Angina pectóris/enfermedad del corazón ___ Si ___ No Enfermedad de los pulmones (asma, COPD, bronquitis crónica ___ Si ___ No Cáncer ___ Si ___ No Depresión o ansiedad ___ Si ___ No Diabetes (no durante el embarazo) ___ Si ___ No Presión arterial alta ___ Si ___ No Colesterol alto ___ Si ___ No Sobrepeso/obesidad ___ Si ___ No 18. Si usted es hombre, ¿Se hace el auto-examen de los testículos? (Si usted es mujer, no conteste esta pregunta) ___ Si ___ No ___ Yo no estoy seguro/yo no sé 19. Si usted es un hombre de 50 años o mayor, ¿Se hace el examen de la próstata? (por ejemplo: el examen de sangre PSA o el examen digital del recto) Si usted es mujer, o un hombre menor de 50, no conteste esta pregunta. ___ Si ___ No ___ Yo no estoy seguro/yo no sé 20. Si usted es mujer, ¿Se hace el auto-examen de los senos regularmente? (Si usted es hombre, no conteste esta pregunta) ___ Si ___ No ___ Yo no estoy segura/yo no sé 21. Si usted es mujer de 40 años o mayor, ¿Se hace una mamografía anualmente (examen de rayos x en el seno)? Si usted es hombre, o una mujer menor de 40, no conteste esta pregunta. ___ Si ___ No ___ Yo no estoy segura/yo no sé 22. Si usted es mujer de 21 años o mayor, ¿Se hace el papanicolau frecuentemente como lo recomienda su doctor, o proveedor de cuidado de salud? Si usted es hombre, o una mujer menor de 21, no conteste esta pregunta. ___ Si ___ No ___ Yo no estoy segura/yo no sé 23. Si usted es hombre o mujer de 50 años o mayor, ¿Alguna vez se ha realizado el examen de cáncer de colon (examen de sangre de materia fecal oculta, sigmoidoscopía, o colonoscopía)? Si usted es menor de 50, no conteste esta pregunta. ___ Si ___ No ___ Yo no estoy seguro(a)/yo no sé 232 APPENDIX 2 42 24. Todos los hombre y las mujeres: ¿Usted se hace el auto chequeo de la piel regularmente (para lunares, cambios en su piel, etc.) ___ Si ___ No ___ Yo no estoy seguro(a)/yo no sé PARTE 4: PREPARACION PARA CASOS DE EMERGENCIA 25. ¿Tiene instalados en su casa detectores de humo y de monóxido de carbono que funcionen? Por favor escoja solo una (1) respuesta. ___ Si, detector de humo solamente ___ Si, los dos tipos ___ Si, detector de monóxido de carbono solamente ___ Yo no estoy seguro(a)/yo no sé 26. ¿Su familia tiene un paquete básico de suministro para emergencias con suficientes artículos para tres (3) días? (Estos paquetes incluyen agua, alimentos no perecederos, los medicamentos con receta que sean necesarios, artículos de primeros auxilios, linternas y pilas, abridor de latas manual, cobijas, etc.) ___ Si ___ No ___ Yo no estoy seguro(a)/yo no sé 27. ¿Cuál sería el medio principal por el cual usted obtendría información de parte de las autoridades en caso de una catástrofe de gran escala o emergencia? Por favor escoja solo una (1) respuesta. ___ Televisión ___ Prensa (periódico) ___ Mensaje de texto o llamada del sistema ___ Radio ___ Página de Web de red social de alerta para emergencias ___ Internet ___ Vecinos, amigos, familia ___ Yo no estoy seguro(a)/yo no sé 28. Si las autoridades públicas decretan una evacuación obligatoria de su barrio o comunidad debido a una catástrofe de gran escala u otra emergencia, ¿Usted evacuaría voluntariamente? ___ Si, yo evacuaría ___ Yo no estoy seguro(a)/yo no sé si evacuaría ___ No, yo no evacuaría 29. Si usted contestó “Yo no estoy seguro(a)/yo no sé “ o “No” ¿Por qué usted no esta seguro(a) o por qué usted no evacuaría? Puede marcar más de una respuesta. ___ No aplica, yo dije que si evacuaría ___ Preocupación acerca de la seguridad de mi familia ___ Falta de transporte ___ Preocupación acerca de dejar mis mascotas ___ Falta de confianza en las autoridades públicas ___ Preocupación sobre atascos de tráfico/poder salir ___ Preocupación acerca de dejar mi propiedad ___ Problemas de salud (no poder ser trasladado) ___ Preocupación acerca de mi seguridad personal ___ Otro 30. ¿Usted está registrado(a) para recibir alertas de las emergencias locales con el sistema de Codigo Rojo “Code Red”? Por favor escoja solo una (1) respuesta. ___ Si ___ No; yo escuché de “Code Red” pero todavía no me he registrado ___ No; yo no sé que es “Code Red” ___ No; yo no sé como registrarme ___ No; yo prefiero no registrarme 233 APPENDIX 2 43 PARTE 5. PREGUNTAS ACERCA DEL DEPARTAMENTO DE SALUD 31. ¿Usted sabe acerca de los servicios que el Departamento de Salud del Condado de Person proporciona (servicios incluyen Cuidado de Salud y Hospicio del Condado de Person, y Salud Ambiental)? ___ Si ___ No 32. ¿Cuál de los siguientes servicios del Departamento de Salud del Condado de Person alguna vez usted a utilizado? Puede marcar más de una respuesta. ___ Yo no he utilizado ninguno de los servicios del departamento de salud ___ Servicios clínicos (ejemplo; vacunas, clínicas de gripe, chequeos de la presión sanguínea, exámenes de laboratorio, método anticonceptivo, visitas de maternidad, pruebas/tratamiento para las enfermedades transmitidas sexuales, visitas de salud infantil, visitas para el control de cancer cervical y de seno, etc.) ___ WIC (Mujures, Infantes, Niños) Servicios de Nutrición ___ Servicios de Salud Ambiental (ejemplo; inspección de restaurante, muetras de agua de pozo, persmiso para el sistema séptico, etc.) ___ Servicios de Cuidado de Salud y Hospicio ___ Servicios de Educación para la Salud (ejemplo; programas de educación, desafíos de pérdida de peso, programas de administración propia para diabetes y enfermedades crónicas, etc). ___ Otro 33. El edificio principal del Departamento de Salud del Condado de Person, el cual acomoda todos los servicios excepto Salud Ambiental, abre de Lunes a Viernes de 8:00 a.m. a 4:30 p.m. ¿Estas horas son suficientes para cumplir con las necesidades de la comunidad? Por favor escoja solo una (1) respuesta ___ Si ___ No ___ Quizás hay la necesidad de extender las horas una noche a la semana 34. La oficina de Salud Ambiental abre de Lunes a Viernes de 8:30 a.m. a 5:00 p.m. ¿Estas horas son suficientes para cumplir con las necesidades de la comunidad? Por favor escoja solo una (1) respuesta ___ Si ___ No Al Departamento de Salud le gustaría recibir sus comentarios y sugerencias. Visite http://health.personcounty.net (preguntas y comentarios), llame al 336-597-2204 x2278 (línea de comentarios) ó llame al 336-597-2204. También hay un chance para Comentario Público durante la reunión de la Junta de Salud (4to Lunes de cada mes a las 7:00 p.m.) PARTE FINAL Tenemos una serie de preguntas finales acerca de usted. Estas preguntas nos ayudarán a comprender la manera en que diferentes tipos de personas ven los distintos problemas de salud. 35. ¿Cuál es el código postal de su residencia primaria dentro del Condado de Person? Por favor escoja solo una (1) respuesta. ___ 27291 ___ 27343 ___ 27565 ___ 27573 ___ 27583 ___ 27305 ___ 27541 ___ 27572 ___ 27574 ___ Other 36. ¿Cuál es su edad? ___ 18-19 ___ 40-49 ___ 65-69 ___ 85 o mayor ___ 20-29 ___ 50-59 ___ 70-79 ___ 30-39 ___ 60-64 ___ 80-85 234 APPENDIX 2 44 37. ¿Usted es hombre o mujer? ____ Hombre ____ Mujer 38. ¿Es usted Hispano, Latino, o de Origen Español? ___ Si ___ No 39. ¿Cuál considera usted que es su raza? Por favor escoja solo una (1) respuesta. ___ Blanca ___ Negra/Afro-Americana únicamente ___ Nativa-Americana /India-Americana/Nativa de Alaska únicamente ___ Asiática (Hindú, Pakistán, Japonesa, China, Korea, Vietnamese, Filipino/a) únicamente ___ Isleña del Pacífico (Nativo-Hawaiiano, Samoano, Guamanian/Chamorro) únicamente ___ Otra raza que no listamos aquí ___ Dos o más razas 40. ¿Cuál es el nivel más alto de escuela, universidad o entrenamiento que usted completó? Por favor escoja solo una (1) respuesta. ___ Menos del 9no grado ___ Un poco de universidad (sin título) ___ 9no – 12vo grado, sin diploma ___ Título universitario (Bachillerato) ___ Diploma de escuela secundaria (GED) ___ Título de postgrado o profesional ___ Título universitario de dos años o ___ Otro entrenamiento vocacional 41. ¿Cuál fué el ingreso total de su hogar el año pasado, antes de impuestos? (Incluyendo todas las personas de 15 años o mayores que viven en su casa y tienen ingresos) Por favor escoja solo una (1) respuesta. ___ Menos de $20,000 ___ $40,000 a $49,999 ___ $70,000 a $79,000 ___ $20,000 a $29,999 ___ $50,000 a $59,999 ___ $80,000 a $99,000 ___ $30,000 a $39,999 ___ $60,000 a $69,000 ___ $100,000 o más 42. ¿A cuántas personas mantiene este ingreso? (Si usted paga por manutención de niños, pero no viven con usted, ellos cuenta como alguien que vive de sus ingresos) Por favor escoja solo una (1) respuesta ___ 1 persona ___ 2 personas ___ 3 o 4 personas ___ 5 o más personas 43. ¿Cuál es su condición laboral? (seleccione todas las respuestas que usted necesita para describir su situación.) ___ Empleado de tiempo completo ___ Desempleado ___ Ama de casa ___ Empleado de medio tiempo ___ Discapacitado ___ Trabajo por cuenta propia ___ Jubilado ___ Estudiante 44. ¿Usted tiene cualquier tipo de cobertura de seguro de salud médico? ____ Si ____ No 45. ¿Su seguro médico de salud cubre las medicinas con prescripción? ____ Si ____ No 235 APPENDIX 2 45 45. ¿Usted tiene acceso a la Internet? ____ Si ____ No ¡Muchas gracias por completar esta Encuesta de Salud Comunitaria! 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Call for Public Hearing for Economic Development Incentives for the Hall’s Agribusiness project Summary of Information: Since January of 2014, Person County Government has been engaged in discussions with Hall’s Agribusiness to encourage them to build approximately 12,000 sq. ft. of newly renovated space in Uptown Roxboro. In third quarter of 2014, the discussions began about an intergovernmental agreement with the City of Roxboro, Person County, RDG and Hall’s Agribusiness. Detailed written agreements among all the parties have been floating back and forth for the last six months and final drafts have been approved by legal counsels for each organization. The City of Roxboro has a public hearing on the proposed intergovernmental agreement scheduled prior to the next Person County Board of Commissioners meeting. If the City of Roxboro approves the proposed intergovernmental agreement, then Person County Government staff recommends that this proposed intergovernmental agreement be presented to the Person County Board of Commissioners on May 4, 2015 (at their regularly-scheduled meeting) and a public hearing be held on the content outlined in the draft written agreement. Person County Board of Commissioners will be provided a draft written intergovernmental agreement in the agenda packet for their May 4th 2015 regularly-scheduled meeting if they approve the recommended action listed below. Recommended Action: Authorize the County Clerk to publish a public notice and establish a public hearing at the May 4, 2015 regularly-scheduled meeting of the Person County Board of Commissioners. Submitted By: Stuart C. Gilbert, Person County Economic Development Director 299 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Appointment of a member to the special Board of Equalization and Review Summary of Information: We received a notice of resignation (see attached) from Mr. Larry Yarborough on April 7, 2015. Mr. Yarborough's time is limited due to his new responsibilities at the state level, and therefore he will not be able to serve as a member of the Special Board of Equalization and Review. The Special Board of Equalization and Review is scheduled to start hearing appeals on April 20, 2015 to 1:00pm. They will hear additional appeals on May 1 at 9:00am, and may need to schedule additional meeting times if all appeals cannot be heard during these 2 meetings. Our adopted resolution requires that all members of the Special Board of Equalization and Review meet the following criteria: 1. Members shall have good moral character and currently reside and own property in Person County. Residency shall have been maintained for a minimum period of 2 years. 2. The term of the members shall be for a term of 4 years. If a vacancy occurs before an incumbent member's term expires, the appointment of the successor shall be for the unexpired term of the member vacating the position. 3. All members shall be selected by the Board of County Commissioners. Recommended Action: Discussion on replacement member and appointment. Submitted By: Russell Jones, Tax Administrator 300 1 Russell Jones From:Larry Yarborough [larryy@hycolake.com] Sent:Tuesday, April 07, 2015 2:00 PM To:Russell Jones Cc:kyle puryear Subject:Re: Board of Equalization and Review Russell, With my new job, I probably should be replaced on the board. I will not be able to meet on the 20th or the first. Thanks, Larry Yarborough Sent from my iPad On Apr 7, 2015, at 8:35 AM, Russell Jones <rjones@personcounty.net> wrote: I have heard from Ms. Bradsher, Mr. Newell , and Curtis Bradsher. We have a quorum for both meetings. I hope the rest of the members can join us for these meetings. I will proceed with the advertising of April 20th at 1pm opening meeting, and May 1st at 9am for adjournment of accepting new appeals. Thanks for your prompt responses. From: Russell Jones Sent: Tuesday, April 07, 2015 9:22 AM To: 'Margaret Bradsher'; 'newell@esinc.net'; 'Bradsher Insurance'; 'Sam Kennington'; 'Larry Yarborough' Cc: Philip Christy; Robin Hensler Subject: FW: Board of Equalization and Review Importance: High The Person County Board of Commissioners met last night and the decision was to keep the special Board of Equalization and Review. I have checked Chairman Bradsher's schedule, and would like to have the first meeting on April 20th at 1pm, and this meeting should be done no later than 4pm. I would also like to meet on May 1st to adjourn receiving new appeals and hear additional appeals. I must hear from a majority of members before noon today in order to advertise the April 20th meeting in Wednesday's paper. Please check your schedules and let me know if April 20 and May 1 will work. Thanks for your quick response to this time sensitive issue. From: Russell Jones Sent: Wednesday, March 18, 2015 2:45 PM To: 'Margaret Bradsher'; 'Larry Yarborough'; 'Bradsher Insurance'; 'Sam Kennington'; 'newell@esinc.net' Cc: Heidi York; Robin Hensler; Philip Christy Subject: FW: Board of Equalization and Review 301 AGENDA ABSTRACT Meeting date: April 20, 2015 Agenda Title: Adoption of Capital Improvement Plan (CIP) for Fiscal Years 2016-2020 Summary of Information: Discussion and approval of the Recommended 5-year CIP that was presented to the Person County Board of Commissioners on April 6, 2015. The adoption of this CIP will allocate funding for the projects in FY 2015-2016 and set the priorities of the projects for the coming fiscal years. Recommended Action: Direct staff on any changes to the document and then adopt the Capital Improvement Plan. Submitted By: and Heidi York, County Manager and Amy Wehrenberg, Finance Director 302 Person County, North Carolina Person County Capital Improvement Plan FY 2016-2020 Recommended Heidi York, County Manager Sybil Tate, Assistant County Manager Amy Wehrenberg, Finance Director April 6, 2015 303 304 Person County, North Carolina Capital Improvement Plan Table of Contents Manager’s Letter to the Board of Commissioners ............................................ 1-2 Objectives and Procedures for the CIP .................................................................3 Criteria for Project Priority .....................................................................................4 Summary of Completed Projects for FY 2015 .......................................................5 Status of Ongoing Projects for FY 2015 ................................................................6 Recommended Projects (By Year) .................................................................... 7-8 Projects Not Recommended ........................................................................... 9-10 Funding Schedule ......................................................................................... 11-13 Set Aside Funds for Future Years ....................................................................... 14 Graph-Revenue Sources ..................................................................................... 15 Graph-Projects by Function ................................................................................. 16 Graph-Projects by Type ...................................................................................... 17 Person County’s Debt Service ...................................................................... 18-20 Future Debt Service Payments ........................................................................... 21 305 PERSON COUNTY OFFICE OF THE COUNTY MANAGER 304 South Morgan Street, Room 212 Roxboro, NC 27573-5245 336-597-1720 Fax 336-599-1609 April 6, 2015 Dear Person County Board of Commissioners: I am pleased to present Person County’s Fiscal Years 2016-2020 Capital Improvement Plan (CIP). The CIP is an important planning tool for our County and is intended to reflect the priorities of the Board of County Commissioners in terms of capital needs and spending over the next five years. In addition to projects for Person County Government, this Plan also incorporates the needs of our partner agencies- both Person County Schools and Piedmont Community College (PCC) - given that counties are statutorily responsible for the provision of educational facilities. To that end, we have taken a proactive approach towards managing both the costs and timing of maintenance projects; namely roofs and windows. We are in our fifth year of implementing a comprehensive roofing assessment for all three entities and our third year of a windows replacement plan primarily for the Person County Schools. The development of this Plan takes into account many factors including the current economic and fiscal climate, the logistical and financial constraints, as well as competing demands and priorities for county funds. The most critical capital needs are those that address a life, safety issue. Once those are known, we work towards a balance of needs and priorities within our logistical and financial constraints. This Plan identifies the anticipated funding sources needed to meet these priorities. Although the projects in this Plan span the next five years, the fiscal effects extend far beyond, particularly projects that will be financed for which the County will incur debt service payments typically over a fifteen to twenty year period. Therefore, the full array of funding sources needed to support the projects, as well as potential impacts to future operating budgets are also presented. The Board of Commissioners reviews the five year CIP every year, but only funds the projects on an annual fiscal year basis. County Fund Balance is a typical and appropriate funding source for the CIP. However, the Board of Commissioners has prioritized a reduction in the use of Fund Balance as that resource has become constrained through its use of operating and recurring expenses over the past several years. The Board has also prioritized several large capital projects to finance in FY15-16 including the construction of a new senior center at an estimated cost of $2.9M and the purchase and up-fit of the Roxboro Little League ballpark projected to cost $560,000. I am recommending that most other major capital needs be deferred into future years to allow the Board to maintain and in some cases increase operations funding, which has been expressed as a priority by the Board as well. The projects recommended to be funded for FY16 total $5.73M. Of this amount, $5.12M will be financed and supported by debt proceeds including General Obligation Bonds for the proposed Senior Center. This updated FY 2016-2020 CIP includes new roofing projects to be financed: Huck Sansbury ($285,189); South Elementary ($268,991); Woodland Elementary ($149,156); Oak Lane Elementary ($207,532); as well as a chiller replacement for Southern Middle School ($300,000) and window replacements at North End Elementary ($329,643) which are also included as part of the financing 1 306 package. Lottery funds will fund a new roof for the Alternative School ($69,781). In addition, other projects proposed for next Fiscal Year 2016 are a chiller replacement for the Law Enforcement Center at $150,000; mandated voting equipment at a cost of $247,400; the second of three payments on a telephone system for county operations for $70,000. Piedmont Community College has an update to their master plan ($50,000) and dining facility equipment upgrades ($20,000). An important element of this CIP is a debt analysis summary, as well as a table and graph showing the future debt service levels for Person County Government. Comparing Person County’s debt service levels with counties benchmarked with our population size indicate that our debt is well below those averages. The spreadsheets and graph illustrate Person County’s ability to take on additional debt payments in the future. Debt Service take a precipitous drop in the upcoming Fiscal Year 2016 even with the proposed financings planned. This sharp drop in debt service is not viewed favorably by financial analysts and bond rating agencies who recommend a steady level of debt with little deviation in either direction. Sharp changes can signal poor planning on a county’s behalf and suggest inefficient use of financing tools. This is something that needs to be considered as projects are evaluated within this CIP. Please keep in mind that this Capital Improvement Plan is just that- a plan, and while a great deal of effort and analysis have gone into this, it offers a starting point for annual comparisons, fiscal changes, unforeseen needs, and a place where public discussion can begin. The CIP will continue to be reviewed throughout the year, presenting any recommended changes to the Board for consideration. This review is critical as new information about our capital needs, our fiscal health, financing tools, and existing project scheduling arises. Person County Government takes great care and pride in being fiscally responsible in providing services. This Capital Improvement Plan is indicative of our commitment to provide residents with not only sustainable infrastructure, but improvements and enhancements to our community and quality of life. County staff looks forward to working with the Board of County Commissioners and our community as we implement the Fiscal Year 2016-2020 Capital Improvement Plan. Sincerely, Heidi N. York County Manager 2 307 Person County, North Carolina Capital Improvement Plan Objectives of a CIP: · Create a plan to organize long term capital needs in a manner to promote discussion regarding priority, feasibility, timing, potential costs, financing options and future budgetary effect. · Limit projects to those costing $50,000 and over in the plan. · Present an overview of requests submitted by Person County departments, Piedmont Community College and Public Schools. · Facilitate the exchange of information and coordination between the County, the community college and the schools on capital planning. Steps in developing a CIP: · Determine capital needs for all departments and certain County-funded agencies. · Review priorities and assess proposed capital projects in relationship to these priorities. · Make recommendations to the Board of County Commissioners on a project’s timing, priority and possible financing options. Categories of projects: Person County Government Piedmont Community College Public Schools · Each project includes a description, a timeline for construction and operating costs, and the current status. · Also included are graphs that summarize revenue sources, projects by function, projects by type, and outstanding debt. 3 308 Person County, North Carolina Capital Improvement Plan Criteria in determining project status: Safety · Is public health or safety a critical factor with regard to this project? · What are the consequences if not approved? Mandate · Is the project required by legal mandates? · Is the project needed to bring the County into compliance with any laws or regulations? Timing and Linkages · What is the relationship to other projects, either ongoing or requested? · Does the project relate to a County-adopted plan or policy? Economic Impact · Will this project promote economic development or otherwise raise the standard of living for our citizens? Efficiencies · Will this project increase productivity or service quality, or respond to a demand for service? · Are there any project alternatives? Service Impact · Will this project provide a critical service or improve the quality of life for our citizens? · How will this project improve services to citizens and other service clients? · How would delays in starting the project affect County services? Operating Budget Impact · What is the possibility of cost escalation over time? · Will this project reduce annual operating costs in some manner? · What would be the impact upon the annual operating budget and future operating budgets? Debt Management · What types of funding sources are available? · How reliable is the funding source recommended for the project? · How would any proposed debt impact the County’s debt capacity? · Does the timing of the proposed construction correspond to the availability of funding? 4 309 Person County, North Carolina Capital Improvement Plan Summary of Completed Projects for FY 2015 Person County: Financing issuance cost: PCRC Purchase & Various Roofing Project - $60,606 Public Schools: Window Replacements: Oak Lane Elementary - $83,582 5 310 Person County, North Carolina Capital Improvement Plan Status of Ongoing Projects for FY 2015 Person County Government: New Telephone System ($90,000) – This project spans three years. The final payment on the lease agreement will be made in 2017. The total project’s cost is $235,229. New Roof – Kirby Civic Auditorium ($335,562) – Completion is set for the end of March 2015. Project is estimated to come in under budget. Upgrade Controls System at LEC ($200,000) – The last bid has been received and the project will be awarded to a vendor soon. This project is scheduled for completion by July 1, 2015. Voting Equipment ($56,795) – IT and Elections staff are gathering quotes for the new voting equipment. The purchase will be made by July 2015. Purchase and Renovation of PCRC ($1,417,050) – The purchase has been completed and renovations are 60% complete. Roof is 95% complete. This project is scheduled for completion by Sept. 1, 2015. Contingency for PCRC renovation ($30,000) –Staff is uncertain at this time if contingency funds will be needed to complete these projects. PCC: Campus Sidewalks Upgrade ($80,000) –This project is 55% complete and anticipated to be completed in April 2015. Public Schools: New Roof - Earl Bradsher ($547,388) – A vendor has been selected and will begin in April; should be complete by July 2015. 6 311 Person County Capital Improvement Plan FY 2016-2020 Recommended Projects YEAR DEPT PROJECT TITLE TOTAL COST PROJECT DESCRIPTION 2016 IT Telephone System 70,000 The County's phone system is outdated and the vendor no longer provides maintenance or repair for this type of system. Payments span over a three year period; total cost is $217,000. General Services New roof - Huck Sansbury 285,189 As recommended in the Roofing Study. General Services Issuance Costs - various re-roofing & equipment upgrades; Roxplex Acquisition/ Improvmts 59,989 Financing costs associated with various roofing projects, equipment upgrades and the Roxplex acquisition and improvements. General Services Chiller replacement - LEC 150,000 Replacement of the Law Enforcement Center's chiller system. Elections Voting equipment 247,400 Includes purchasing tabulators and AutoMark machines. The tabulators and the AutoMark machines are needed for 2016. Rec, Arts & Parks Senior Center 2,900,000 Construction of a new Senior Center in Uptown Roxboro. Includes architectural and engineering costs. Rec, Arts & Parks Issuance costs - Senior Center 60,000 Financing costs associated with the Senior Center project. Rec, Arts & Parks Roxplex Acquisition/Improvement 559,500 Purchase and upgrades to the Roxplex Little League facility. PCC Master Plan Update/Feasibility Study 50,000 The Master Plan was last updated in 2008 and needs to be updated to reflect economic changes. Once the master plan is updated, a feasibility study will be conducted for the Allied Health Building and an additional access route. PCC Dining Facility Equipment Upgrades 20,000 Dining facility equipment does not allow for expanded food service. Payments span a three year period; total cost is $60,000. Public Schools New roof - VFW 69,781 As recommended in the Roofing Study. Public Schools New roof - South Elementary 268,991 As recommended in the Roofing Study. Public Schools New roof - Woodland Elementary 149,156 As recommended in the Roofing Study. Public Schools New roof - Oak Lane Elementary 207,532 As recommended in the Roofing Study. Public Schools Chiller replacement- SMS 300,000 Chiller is 20 years old and in need of major repairs. Cost of repair is not justifiable, considering the age of the chiller. Public Schools Window Replacements - North End 329,643 As recommended in the Window Study. 2017 IT Telephone System 75,229 The County's phone system is outdated and the vendor no longer provides maintenance or repair for this type of system. Payments span over a three year period; total cost is $217,000. Public Safety Public Safety Communication System 3,587,350 Construct 3 towers to provide 95% coverage for public safety departments. Public Safety Broadband equipment 88,650 Broadband equipment to provide service to unserved areas. PI/PCRC PCRC/PI Merger 683,500 Merge PI and PCRC into one building. Includes moving costs and upgrades to the interior of the facility to increase efficiencies. Construction of roof for outside storage and 5,000 sq ft of conditioned space for PI employees. PCC New roof - Building D and walkways 226,156 As recommended in the Roofing Study. PCC Upgrade campus-wide HVAC 100,000 Controls are outdated and it is difficult to maintain/replace parts. PCC Dining Facility Equipment Upgrades 20,000 Dining facility equipment does not allow for expanded food service. Payments span a three year period; total cost is $60,000. PCC New Allied Health Building (infrastructure) 100,000 PCC will grow in the areas of Allied Health and Workforce training. New buildings need to be built for these programs. Roads, water, and sewer need to be extended to this property. Payments span a four year period; total cost is $1.25M. Public Schools New roof- North Elementary 223,925 As recommended in the Roofing Study. 7 312 Person County Capital Improvement Plan FY 2016-2020 Recommended Projects YEAR DEPT PROJECT TITLE TOTAL COST PROJECT DESCRIPTION 2018 General Services New roof- EMS 147,419 As recommended in the Roofing Study. General Services New roof- Elections/IT 100,479 As recommended in the Roofing Study. General Services New roof - Library 72,986 As recommended in the Roofing Study. Library Southern Satellite at Helena 368,500 Renovate FFA building on Old Helena School campus to create a new library branch. Rec, Arts & Parks Recreation Center 3,040,000 Construct a Recreation Center. Rec, Arts & Parks Light Replacement 100,000 This project spans three years; total cost is $300K. Current system is 25+ yrs old. Airport Hangar Construction 800,000 The Airport Commission has recommended construction of a new hangar. PCC New roof- Bldg. L 110,642 As recommended in the Roofing Study. PCC Upgrade campus-wide HVAC 100,000 Controls are outdated and it is difficult to maintain/replace parts. PCC Dining Facility Equipment Upgrades 20,000 Dining facility equipment does not allow for expanded food service. Payments span a three year period; total cost is $60,000. PCC New Allied Health Building (infrastructure) 100,000 PCC will grow in the areas of Allied Health and Workforce training. New buildings need to be built for these programs. Roads, water, and sewer need to be extended to this property. Payments span a four year period; total cost is $1.25M. Public Schools Valve Replacement - South Elementary 105,000 Valves are failing, causing heating and cooling issues in the school. 2019 Rec, Arts & Parks ADA Accessibility for Park Facilities 60,000 Improve ADA accessible parking and routes to access park amenities. Rec, Arts & Parks Light Replacement- Bushy Fork Park 52,490 Replace Bushy Fork's ball field lights. Current lighting system uses oil-based transformers and poses safety problems. Rec, Arts & Parks Kirby Auditorium- seating replacement 85,000 Current seating at the Kirby is very outdated and in some cases pose a hazard for the patrons visiting to watch shows. The current theater seating was last replaced in the late 70's. Rec, Arts & Parks Light Replacement 100,000 This project spans three years; total cost is $300K. Current system is 25+ yrs. old. PCC Upgrade campus-wide HVAC 100,000 Controls are outdated and it is difficult to maintain/replace parts. PCC New Allied Health Building (infrastructure) 400,000 PCC will grow in the areas of Allied Health and Workforce training. New buildings need to be built for these programs. Roads, water, and sewer need to be extended to this property. Payments span a four year period; total cost is $1.25M. Public Schools Chiller Replacement- PHS 325,000 Chiller is 23+ years old and is coming to the end of life for this unit. 2020 General Services New Roof- Courthouse 120,471 As recommended in the Roofing Study. General Services New Roof - Museum complex and assoc. buildings 327,306 As recommended in the Roofing Study. Rec, Arts & Parks Light Replacement 100,000 This project spans three years; total cost is $300K. Current system is 25+ yrs. old. PCC New Allied Health Building (infrastructure) 650,000 PCC will grow in the areas of Allied Health and Workforce training. New buildings need to be built for these programs. Roads, water, and sewer need to be extended to this property. Payments span a four year period; total cost is $1.25M. Public Schools New roof - Southern Middle 52,033 As recommended in the Roofing Study. Public Schools New roof - Early Intervention 188,164 As recommended in the Roofing Study. 8 313 Person County Capital Improvement Plan FY 2016-2020 Projects Not Recommended DEPT PROJECT TITLE TOTAL COST PROJECT DESCRIPTION/REASON FOR NOT RECOMMENDING General Services New Roof - Museum, concession stands 64,764 As recommended in the roofing study. Not recommended at this time due to more critical needs. General Services New Roof - Misc. small roofs (airport, Mayo, Museum, etc)217,639 As recommended in the roofing study. Not recommended at this time due to more critical needs. General Services New Roof - Animal Services 199,255 As recommended in the roofing study. Not recommended at this time due to more critical needs. General Services New Roof - Grounds maintenance, concessions 77,144 As recommended in the roofing study. Not recommended at this time due to more critical needs. General Services New Roof - Inspections 117,614 As recommended in the roofing study. Not recommended at this time due to more critical needs. General Services Replace carpet & tile (PCOB)124,350 Replace BOE carpet and first floor tile in PCOB. First floor tile replacement incorporated into operating budget. General Services New Roof - Helena School Complex 1,076,099 As recommended in the roofing study. Not recommended at this time due to more critical needs. Rec, Arts & Parks Olive Hill Restroom Project 55,000 Includes construction of outdoor restrooms at Olive Hill. Not recommended at this time. Rec, Arts & Parks Outdoor Multi-Purpose Courts 60,000 Includes additional multi-use courts at Olive Hill, Allensville, Hurdle Mills, Bushy Fork and Bethel Hill. The Roxplex will provide additional recreational opportunities, so this project is not needed at this time. Rec, Arts & Parks Gym renovations (Huck Sansbury, O.H., Helena)65,000 Includes painting, floor restoration, new fixtures, and bathroom upgrades to meet ADA standards. These are ongoing maintenance costs and have been moved to the operating budget. Rec, Arts & Parks Score Board Replacements and Repairs 65,000 Includes replacing and upgrading scoreboards at all recreational locations. These are ongoing maintenance costs and have been moved to the operating budget. PCC Architectural Plans for Building A Upgrade 75,000 This study would include renovation and expansion of Building A that would allow for additional office and meeting space. The results of the Master Plan may impact this project, so it is not recommended at this time. PCC Architectural Plans for Building D Upgrade (Barnette Auditorium)75,000 Includes updated lighting, HVAC, seating, desks and new finishes. The results of the Master Plan may impact this project, so it is not recommended at this time. PCC Architectural Plans for Upgrade of BDEC 75,000 Includes renovation of the upstairs of the BDEC building to incorporate the Work Force Development Training Center. The results of the Master Plan may impact this project, so it is not recommended at this time. PCC Construct covered walkways 205,000 Construct a covered walkway from Building A to Building S. Not recommended at this time. PCC Building A Upgrades 250,000 Includes improvements to offices and meeting spaces. The results of the Master Plan may impact this project, so it is not recommended at this time. PCC Building D Upgrades 250,000 Includes improvements to the auditorium, classrooms, bathrooms and office areas. The results of the Master Plan may impact this project, so it is not recommended at this time. PCC BDEC Upgrades 250,000 Includes installing an elevator, staircase and improvements to upstairs. The results of the Master Plan may impact this project, so it is not recommended at this time. 9 314 Person County Capital Improvement Plan FY 2016-2020 Projects Not Recommended DEPT PROJECT TITLE TOTAL COST PROJECT DESCRIPTION/REASON FOR NOT RECOMMENDING Public Schools New Roof - Helena Elementary 1,644,232 As recommended in the roofing study. Not recommended at this time due to more critical needs. Public Schools New Roof - School Maintenance 296,358 As recommended in the roofing study. Not recommended at this time due to more critical needs. Public Schools New Roof - School Bus Garage 269,826 As recommended in the roofing study. Not recommended at this time due to more critical needs. Public Schools Window Replacements - North End Elementary 329,643 As recommended in the window study. Not recommended at this time due to more critical needs. Public Schools Upper Tennis Courts-PHS 200,000 Replace upper tennis courts. Not recommended at this time due to more critical needs. Public Schools Artificial Turf- PHS 165,000 Replace football field turf with artificial surface. Not recommended at this time due to more critical needs. 10 315 Person County Capital Improvement Plan (CIP) 2016-2020 Recommended - Funding Schedule Revenues: County Contribution 202,975 237,400 1,328,810 1,246,026 1,272,490 1,202,244 5,489,945 CIP Project Fund Balance 438,820 300,000 100,000 65,000 236,000 1,139,820 Airport Construction Fund Balance 800,000 800,000 Debt Proceeds - PCRC Acquisition/Improvements and Various Re-roofing 2,360,000 2,360,000 Debt Proceeds - Senior Center Project 2,960,000 2,960,000 Debt Proceeds - Various Re-roofing and Equipment Upgrades; Roxplex Acquisition/Improvements 2,160,000 2,160,000 Debt Proceeds - Public Safety Cell Towers 3,676,000 3,676,000 Debt Proceeds - Recreation Center Project 3,040,000 3,040,000 Lottery proceeds-VFW Roofing 69,781 69,781 Total Sources of Revenue:3,001,795 5,727,181 5,104,810 5,151,026 1,272,490 1,438,244 21,695,546 Project Costs for County: Current Year 2014-15 Budget Year 2015-16 Planning Year 2016-17 Planning Year 2017-18 Planning Year 2018-19 Planning Year 2019-20 TOTAL PROJECT COSTS Information Technology: Telephone System 90,000 70,000 75,229 235,229 General Services: New roof-Kirby Civic Auditorium 335,562 335,562 Upgrade controls system at LEC 200,000 200,000 New roof-Huck Sansbury (Annex & Workforce)285,189 285,189 Issuance Costs-Various Re-roofing and Equipment Upgrades; Roxplex Acquisition/Improvements 59,989 59,989 Chiller replacement - LEC 150,000 150,000 New roof-Emergency Medical Services 147,419 147,419 New roof-Board of Elections/IT 100,479 100,479 New roof - Library 72,986 72,986 New roof- Courthouse 120,741 120,741 New roof - Museum complex & associated buildings 327,306 327,306 Elections Voting Equipment 56,795 247,400 304,195 Emergency Management Services: Public Safety Towers 3,587,350 3,587,350 Broadband Equipment 88,650 88,650 Library Southern Satellite Library 368,500 368,500 Recreation, Arts & Parks: Senior Center Project 2,900,000 2,900,000 Issuance Costs-Senior Center Project 60,000 60,000 Roxplex Acquisition/Improvements 559,500 559,500 ADA Accessibility for Park facilities 60,000 60,000 Light Replacement - Bushy Fork Park 52,490 52,490 Recreation Center Project 3,040,000 3,040,000 Kirby Auditorium: seating replacements 85,000 85,000 Light Replacement - all parks 100,000 100,000 100,000 300,000 Person Industries/Material Recycling Center: PCRC Acquisition/Improvements 1,417,050 1,417,050 Issuance Costs-PCRC Acquisition/Improvements and Various Re-roofing 60,000 60,000 Contingency-PCRC Renovation 30,000 30,000 PCRC/PI Merger 683,500 683,500 Sources of Revenue for Project Costs: Budget Year 2015-16 Planning Year 2017-18 Planning Year 2019-20 TOTAL REVENUE SOURCES Current Year 2014-15 Planning Year 2016-17 Planning Year 2018-19 11 316 Person County Capital Improvement Plan (CIP) 2016-2020 Recommended - Funding Schedule Airport Construction Projects: Hangar construction 800,000 800,000 Set -asides for future projects 100,000 86,000 150,000 336,000 Total County Projects 2,289,407 4,332,078 4,434,729 4,715,384 447,490 548,047 16,767,135 Project Costs for PCC: Current Year 2014-15 Budget Year 2015-16 Planning Year 2016-17 Planning Year 2017-18 Planning Year 2018-19 Planning Year 2019-20 TOTAL PROJECT COSTS Piedmont Community College (PCC): Campus Sidewalks Upgrade 80,000 80,000 New roof-Bldg. D and walkways 226,156 226,156 New roof-L Building 110,642 110,642 Master Plan Update/Feasibility Study 50,000 50,000 Upgrade campus-wide HVAC 100,000 100,000 100,000 300,000 Dining Facility equipment upgrades 20,000 20,000 20,000 60,000 New Allied Health Building (Infrastructure)100,000 100,000 400,000 650,000 1,250,000 Set -asides for future projects - Total PCC 80,000 70,000 446,156 330,642 500,000 650,000 2,076,798 Project Costs for Public Schools: Current Year 2014-15 Budget Year 2015-16 Planning Year 2016-17 Planning Year 2017-18 Planning Year 2018-19 Planning Year 2019-20 TOTAL PROJECT COSTS Public Schools: New roof-Earl Bradsher Preschool 547,388 547,388 Window replacements-Oak Lane Elementary 85,000 85,000 New roof-VFW (Alternative School)69,781 69,781 New roof-South Elementary 268,991 268,991 New roof-Woodland Elementary 149,156 149,156 New roof-Oak Lane Elementary 207,532 207,532 Chiller replacement-Southern Middle School 300,000 300,000 Window replacements-North End Elementary 329,643 329,643 New Roof-North Elementary 223,925 223,925 Valve Replacement-South Elementary 105,000 105,000 Chiller replacement-PHS 325,000 325,000 New roof-Southern Middle School 52,033 52,033 New roof-Early Intervention 188,164 188,164 Set -asides for future projects - Total Public Schools Projects:632,388 1,325,103 223,925 105,000 325,000 240,197 2,851,613 Total Project Costs:3,001,795 5,727,181 5,104,810 5,151,026 1,272,490 1,438,244 21,695,546 12 317 Person County Capital Improvement Plan (CIP) 2016-2020 Recommended - Funding Schedule Sources of Revenue for Operating Impact Costs: Current Year 2014-15 Budget Year 2015-16 Planning Year 2016-17 Planning Year 2017-18 Planning Year 2018-19 Planning Year 2019-20 TOTAL REVENUE SOURCES General Fund Contribution 110,878 784,886 754,227 1,113,012 1,027,132 975,712 4,765,847 Fees (Southern Satellite Library)10,000 10,000 20,000 Fees (Roxplex Center)73,902 73,902 73,902 73,902 295,608 Fees (Recreation Center)100,000 100,000 200,000 Increase in PCRC/PI program revenues 52,000 52,000 52,000 156,000 Total Sources of Revenue for Operating Impact Costs 110,878 784,886 828,129 1,238,914 1,263,034 1,211,614 5,437,455 Operating Impact Costs: Current Year 2014-15 Budget Year 2015-16 Planning Year 2016-17 Planning Year 2017-18 Planning Year 2018-19 Planning Year 2019-20 TOTAL PROJECT COSTS Public Safety Tower Project 3,385 3,385 3,385 10,155 Broadband Equipment 23,550 49,810 23,550 96,910 Southern Satellite Library 75,100 75,100 150,200 Roxplex Center Project 806 80,919 80,919 80,919 80,919 324,482 PCRC building rent (26,751) (107,000) (107,000) (107,000) (107,000) (107,000) (561,751) PCRC/PI Merger efficiencies (40,000) (40,000) (40,000) (40,000) (160,000) Airport hangar construction 1,500 1,500 3,000 Debt Service impacts with proposed debt 137,629 891,080 870,660 1,251,800 1,225,580 1,197,710 5,574,459 Total Operating Impact Costs 110,878 784,886 828,129 1,238,914 1,263,034 1,211,614 5,437,455 Note: Items highlighted in blue and red are projects associated with a debt financing. 2014-15 PCRC Acquisition/Improvements and Various Re-roofing 2015-16 Senior Center Project 2015-16 Various Re-roofing and Equipment Upgrades; Roxplex Acquisition/Improvements 2016-17 Public Safety Tower Project 2017-18 Recreation Center Until more decisions are made, this project has been placed in the CIP to finance in FY 2017-18. The location and scope of this project is undetermined. The recommendation above assumes the use of the remaining GO Bond Issue of $3.04M. An extension of the G.O. Bond authority will be necessary if the Board of Commissioners wish to finance this project with the issuance of bonds. The extension will provide for 3 more years from November 8, 2015 to issue bonds for this purpose. The County entered into an installment purchase contract for $2.36 million on November 6, 2014 with BB&T to finance a portion of the cost of acquisition and land improvement of the Person County Recycling Center (PCRC); the re-roofing of Earl Bradsher Preschool; and the re-roofing of the Kirby Civic Auditorium. The Board of Commissioners are in negotiations with the City of Roxboro on several property options for the future location of the Senior Center. Final decisions about the scope of this project have not been made. Until further determined, the CIP grid above assumes a General Obligation Bond Issue to finance $2.96 million which would cover property acquisition, construction, and renovation for the purposes of providing improved Senior Center facilities. Since another financing is proposed in the same year for roofing and the Roxplex acquisition and improvements, other loan recommendations may be forthcoming to minimize the County's debt cost. The timing of when these two projects become "shovel-ready" will have a significant impact on the financing method recommended. Due to the large amount of roofing to be completed in accordance with the County's Roofing Study and the current condition of these roofs, a recommendation is included to finance this cost, as well as window replacements at North End Elementary, a boiler replacement at Southern Middle School, and the acquisition and improvements to the Roxplex property for $2.16 million. As stated above for the Senior Center financing, which is also proposed for 2015-16, determinations associated with this financing may be altered in an attempt to minimize the County's debt cost. Hired consultants conducted a feasibility study which resulted in the recommendation to construct three, 300 foot towers and installing Simulcast public safety communication equipment. It also included the cost of providing grant funds to a private broadband provider to hang broadband equipment on the towers for a total project cost of approximately $4M. The Commissioners approved $100,000 in the FY15 budget to pay for environmental studies to be conducted at the three potential tower locations. Currently, the environmental studies are underway and should be completed by the end of FY15. The project is scheduled to be completed in December 2016. Loan terms and amounts are to be determined. 13 318 Set-Aside Amount Fiscal Year that project is recommended to take place Remaining Cost Current & Prior Years Chiller replacement - LEC 100,000$ 2016 50,000$ Upgrade campus-wide HVAC 100,000 2017 200,000 New roof-Board of Elections/IT 65,000 2018 35,479 Total 265,000$ Planning Year 2015-2016 (No set asides proposed in this year)-$ Planning Year 2016-2017 (No set asides proposed in this year)-$ Planning Year 2017-2018 New roof - Museum complex & associated buildings 86,000$ 2020 241,306$ Planning Year 2018-2019 New roof - Museum complex & associated buildings 100,000$ 2020 141,306$ New roof- Courthouse 50,000 2020 70,741 150,000$ Planning Year 2019-2020 (No set asides proposed in this year)-$ Note: The County implements a best practice approach for distributing the costs of capital projects to minimize the impact in any one fiscal year. This is accomplished by incrementally funding expensive projects over multiple fiscal years. The projects listed below are funded through set- aside funds leading up to the year in which the project will be completed, thus reducing the burden in that year. This is a proactive approach to planning and funding future capital needs as well as maximizing cash flow capacity. Set-Aside Funds for Future Years 14 319 Person County Capital Improvement Plan Recommended - Revenue Sources FY 2016 - 2020 Total % Revenue Sources Description Current Year 2016 2017 2018 2019 2020 Totals % of Total GF Fund Balance 202,975 237,400 1,328,810 1,246,026 1,272,490 1,202,244 5,489,945 25.3% CIP Project Fund Balance 438,820 300,000 100,000 65,000 - 236,000 1,139,820 5.3% Airport Capital Projects Fund Balance - - - 800,000 - - 800,000 3.7% Debt Proceeds 2,360,000 5,120,000 3,676,000 3,040,000 - - 14,196,000 65.4% Lottery Proceeds - 69,781 - - - - 69,781 0.3% Totals 3,001,795 5,727,181 5,104,810 5,151,026 1,272,490 1,438,244 21,695,546 100.0% GF Fund Balance 25.3% CIP Project Fund Balance 5.3% Airport Capital Projects Fund Balance 3.7% Debt Proceeds - 65.4% Lottery Proceeds - 0.3% 15 320 Person County Capital Improvement Plan Recommended - by Function FY 2016 - 2020 Total % CIP Projects by Function Description Current Year 2016 2017 2018 2019 2020 Totals % of Total General Government 782,357 3,772,578 75,229 406,884 150,000 448,047 5,635,095 26.0% Public Safety - - 3,676,000 - - - 3,676,000 16.9% Environmental Protection (Recycling Center) 1,507,050 - 683,500 - - - 2,190,550 10.1% Culture & Recreation - 559,500 - 3,508,500 297,490 100,000 4,465,490 20.6% Transportation (Airport) - - - 800,000 - - 800,000 3.7% Education - PCC 80,000 70,000 446,156 330,642 500,000 650,000 2,076,798 9.6% Education - Schools 632,388 1,325,103 223,925 105,000 325,000 240,197 2,851,613 13.1% Totals 3,001,795 5,727,181 5,104,810 5,151,026 1,272,490 1,438,244 21,695,546 100.0% General Government 26.0% Public Safety 16.9% Environmental Protection (Recycling Center) 10.1% Culture & Recreation 20.6% Transportation (Airport) 3.7% Education - PCC 9.6% Education - Schools 13.1% 16 321 Person County Capital Improvement Plan Recommended - by Type FY 2016 - 2020 Total % CIP Projects by Type Description Current Year 2016 2017 2018 2019 2020 Totals % of Total Construction/Renovation 1,507,050 3,519,500 4,370,850 4,308,500 400,000 650,000 14,755,900 68.0% Roofing Replacements 882,950 1,040,638 450,081 431,526 - 688,244 3,493,439 16.1% Equipment Upgrades 346,795 787,400 183,879 225,000 477,490 100,000 2,120,564 9.8% Other B&G Improvements 80,000 50,000 100,000 100,000 245,000 - 575,000 2.7% Window Replacements 85,000 329,643 - - - - 414,643 1.9% Set-Asides 100,000 - - 86,000 150,000 - 336,000 1.5% Totals 3,001,795 5,727,181 5,104,810 5,151,026 1,272,490 1,438,244 21,695,546 100.0% 68.0% 16.1% 9.8% 2.7% 1.9% 1.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% Construction/Renovation Roofing Replacements Equipment Upgrades Other B&G Improvements Window Replacements Set-Asides 17 322 Person County's Debt Service Current Debt Service Project Description Term Int Rate % Outstanding Balance Last Pyt Fiscal Year 2006 Various Roofing/Paving Re-roofing, paving and repaving certain school, community college and other public facilities; re-floor the gymnasium; construct new tennis courts at Person High School 15 years 3.86% $2,414,590 2021 2010 Courthouse Renovation & Various Roofing (BAB’s) Engineering and construction costs associated with the renovation of the Courthouse and some various re- roofing for certain school, community college and other public facilities; financed through Build America Bonds (BAB’s) yielding a 35% refund of the interest payments 10 years 4.08% 2,902,960 2021 2012 SMS & portion of PHS Re-roofing (QSCB) Re-roofing construction for Southern Middle School and a portion of Person High School; financed through a Qualified School Construction Bond (QSCB) yielding a 100% refund of the interest payments 15 years 3.93% 3,277,287 2028 2014 Capital Equipment Lease (Telephone Equipment) Replacement of primary phone system; financed as a capital equipment lease for a 3 year term 3 years 4.55% 145,229 2017 2015 PCRC Purchase/ Renovation & Various Roofing Projects Purchase, renovation and re-roofing of the existing Person County Recycling Facility, and re-roofing construction for the Kirby Civic Auditorium and Earl Bradsher Preschool 15 years 2.80% 2,639,540 2029 TOTAL DEBT SERVICE OUTSTANDING $11,379,606 18 323 Current Debt Analysis There are two standard ratios that measure debt service levels and the capacity for taking on additional debt. These ratios and their meaning for Person County are described below: · Debt to Assets Ratio: Measures leverage, the extent to which total assets are financed with long-term debt. The debt-to-assets ratio is calculated as long-term debt divided by total assets. A high debt to assets ratio may indicate an over-reliance on debt for financing assets, and a low ratio may indicate a weak management of reserves. At FY 2013, the debt to assets ratio for Person County was 27%, while counties with similar populations were at 51%. Although Person County was at the mid-range for the amount of total assets reported in comparison to these other counties, Person County had the 3rd lowest Debt to Assets Ratio, as well as the 5th lowest long term debt amount. A more applicable comparison may be to view the debt to assets ratio for Person County since FY 2010. As displayed in the following chart, Person County's debt to assets ratio has declined from 35% in FY 2010 to 21% in FY 2014. This reduction can likely be attributed to conservative spending in uncertain economic conditions and the attempt to build-up of reserves during this five year period. This increase in the County's cash reserves (assets) causes a decrease in this ratio. Another variable causing this downward trend is the large $2M yearly pay down of the 2008 Refinanced Debt for the 1999 & 2000 Elementary School Construction and Law Enforcement Center debt. Even though the County has issued new debt since 2008, the historically low interest rates have generated significantly lower debt payments than the previous years’ debt financings. This decreasing trend is likely to continue until the 2008 debt ceases with the last payment in 2015. After this debt is defeased and new debt is issued, it is likely that this percentage will begin moving slowly upwards again, indicating to credit agencies a more strategic approach to the management of the County’s assets. Person County's FY Debt to Assets Ratio 2010 35% 2011 36% 2012 29% 2013 27% 2014 21% · Debt Service Ratio: Measures financing obligations, provides feedback on service flexibility with the amount of expenditures committed to annual debt service. The debt service ratio is calculated as annual debt service divided by total expenses. General accounting guidance discourages this ratio from being higher than 15% for a maximum benchmark. Any percentage higher than this can severely hamper the County's service flexibility. Person County's debt service ratio of 8% is well below the population group of 11% for FY 2013 (Person County's ratio stays flat at 8% for FY 2014). Due to the expected debt reductions in fiscal years 2015 and 2016, it is anticipated that Person County's debt service ratio will substantially decrease unless additional debt is acquired to support the leveling out of this ratio. A consistent debt ratio level would indicate a stronger management of financing resources in relation to the amount that is available for other services. Debt Service FY 2013 Ratio Person County 8% Population Group 11% Maximum Benchmark 15% 19 324 New Debt Service The four proposed financings in Person County's 2016-2020 plan are recommended below: FY 2016 Senior Center Project A General Obligation (G.O.) Bond issue is proposed to cover the construction and renovation of properties recently acquired from the City of Roxboro to provide improved facilities for the County's senior citizens that have been previously displaced from the current Senior Center location. Five plan options were presented to the Board of Commissioners on March 16, 2015 by contracted engineers for consideration. The costs ranged from $2.2M to $3.1M. Until further determined, the total proposed debt amount for these projects is $2,960,000 and is comprised of the following: Construction and Renovation: Senior Center $ 2,900,000 Issuance costs 60,000 Total $ 2,960,000 FY 2016 Various Re-roofing and Equipment Upgrades; Roxplex Acquisition /Improvements A debt borrowing is proposed to cover the roof replacements for Huck Sansbury Workforce building and various school buildings, window replacements for North End Elementary, a boiler replacement at Southern Middle School, and the acquisition and improvements to the Roxplex property. The total proposed debt amount for these projects is $2,160,000 and is comprised of the following: Re-roofing: Huck Sansbury Complex $ 285,189 Re-roofing: South Elementary 268,991 Re-roofing: Woodland Elementary 149,156 Re-roofing: Oak Lane Elementary 207,532 Window Replacements: North End Elementary 329,643 Chiller Replacement: Southern Middle School 300,000 Acquisition/Improvements: Roxplex Center 559,500 Issuance costs 59,989 Total $ 2,160,000 FY 2017 Public Safety Towers and Broadband Equipment A debt borrowing is proposed to cover the construction of three, 300 foot towers and installing Simulcast public safety communication equipment. Also included is the cost of providing grant funds to a private broadband provider to hang broadband equipment on the towers. Currently, the environmental studies are underway and should be completed by the end of FY 2015. Until further determined, the total proposed debt amount for this project is $3,676,000 and is comprised of the following: Construction/Engineering: cell towers $ 3,587,350 Broadband Equipment Installation 88,650 Total $ 3,676,000 FY 2016 Recreation Center Project A G.O. Bond issue is proposed to cover the possible construction of a Recreation Center for improved recreational facilities. The location and scope of this project is undetermined. The recommendation assumes the use of the remaining G.O. Bond Issuance after the costs of the Senior Center Project have been applied. Until further determined, the total proposed debt amount for these projects is $3,040,000 and is comprised of the following: Construction and Renovation: Senior Center $ 3,040,000 20 325 Future Debt Service Payments for Person County Fiscal Year Ending June 30 2006 Various roofing/paving projects 2008 Refinancing of 1999 & 2000 Schools/LEC Bldg 2010 Courthouse Renovation & Various Roofing Projects 2012 School Roofing Projects for SMS & PHS (QSCB) 2014 Capital Equipment Lease (Teleph Equip) 2015 PCRC Purchase/ Renovation & Various Roofing Projects Total Current Debt Service Year to Year Change in Current Debt Service 2015 313,545 2,286,356 932,600 317,582 90,000 137,629 4,077,712 (129,997) 2016 329,831 - 899,960 309,375 70,000 460,480 2,069,646 (2,008,066) 2017 319,969 - 867,320 301,167 75,229 210,960 1,774,645 (295,001) 2018 483,635 - 339,780 292,960 - 246,200 1,362,575 (412,070) 2019 442,471 - 327,540 284,753 - 141,300 1,196,064 (166,511) 2020 427,094 - 315,300 276,546 - 138,500 1,157,440 (38,624) 2021 411,591 - 153,060 268,338 - 135,700 968,689 (188,751) 2022 - - - 260,131 - 430,800 690,931 (277,758) 2023 - - - 251,924 - 221,000 472,924 (218,007) 2024 - - - 243,717 - 116,100 359,817 (113,107) 2025 - - - 235,509 - 113,300 348,809 (11,008) 2026 - - - 227,302 - 110,500 337,802 (11,007) 2027 - - - 219,095 - 107,700 326,795 (11,007) 2028 - - - 106,470 - 104,900 211,370 (115,425) 2029 - - - - - 102,100 102,100 (109,270) 2030 - - - - - - (102,100) Totals 2,728,135$ 2,286,356$ 3,835,560$ 3,594,869$ 235,229$ 2,777,169$ 15,457,318$ (4,207,709)$ Fiscal Year Ending June 30 Total Current Debt Service 2016 Proposed - Senior Center Project (assumptions: 3.5%, 20 yrs) 2016 Proposed - Roofing & Equipment Upgrades; Roxplex Acquisition & Improvements (assumptions: 3.5%, 15 yrs) 2017 Proposed - Public Safety Cell Towers (assumptions: 3.75%, 15 yrs) 2018 Proposed - Recreation Center Project (assumptions: 3.5%, 20 yrs) Total Proposed Debt Service Adjusted Year to Year Change with Proposed Debt Service 2015 4,077,712 - - - - 4,077,712 (129,997) 2016 2,069,646 255,000 175,600 - - 2,500,246 (1,577,466) 2017 1,774,645 249,750 172,100 237,850 - 2,434,345 (65,901) 2018 1,362,575 244,500 268,600 234,100 258,400 2,368,175 (66,170) 2019 1,196,064 239,250 261,600 330,350 253,080 2,280,344 (87,831) 2020 1,157,440 234,000 154,600 422,850 247,760 2,216,650 (63,694) 2021 968,689 228,750 251,100 411,600 242,440 2,102,579 (114,071) 2022 690,931 223,500 344,100 400,350 237,120 1,896,001 (206,578) 2023 472,924 218,250 233,600 465,100 231,800 1,621,674 (274,327) 2024 359,817 213,000 186,600 375,000 226,480 1,360,897 (260,777) 2025 348,809 207,750 121,000 363,750 221,160 1,262,469 (98,428) 2026 337,802 202,500 117,500 352,500 215,840 1,226,142 (36,327) 2027 326,795 197,250 114,000 241,250 210,520 1,089,815 (136,327) 2028 211,370 192,000 110,500 233,750 205,200 952,820 (136,995) 2029 102,100 186,750 107,000 226,250 199,880 821,980 (130,840) 2030 - 181,500 103,500 318,750 194,560 798,310 (23,670) 2031 - 176,250 - 207,500 189,240 572,990 (225,320) 2032 - 171,000 - - 183,920 354,920 (218,070) 2033 - 165,750 - - 178,600 344,350 (10,570) 2034 - 160,500 - - 173,280 333,780 (10,570) 2035 - 155,250 - - 167,960 323,210 (10,570) 2036 - - - - 162,640 162,640 (160,570) 2037 - - - - 157,320 157,320 (5,320) 2038 - - - - - - (157,320) Totals 15,457,318$ 4,102,500$ 2,721,400$ 4,820,950$ 4,157,200$ 31,259,368$ (4,207,709)$ The above chart displays Person County's current debt service schedule. A large amount of debt drops off in fiscal year 2016 for $2.0M. The sharp decline in debt obligations and the availability of low interest rates creates an enviroment that is suitable for taking on additional debt as proposed in the chart to the right. The blue line in the graph below includes the new proposed debt and indicates a more gradual dropoff of debt compared to the red line showing our current debt service schedule. - 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000 4,500,000 Total Current Debt Service Total Proposed Debt Service 21 326 AGENDA ABSTRACT Meeting Date: April 20, 2015 Agenda Title: Proposal to Lease to the State of NC Background: The County and the Board of Education recently amended the Woodland School lease document to allow the County to lease to the State a small piece of the property for the construction of a VIPER tower. Summary of Information: Attached is a document that the State requires us to submit in order to begin the leasing process. If the BOC signs the document, the Attorney General’s office will draft a lease document for the Board to review and approve. The drafting process can take a year or more. Representatives from the State will present the draft of the lease. Recommended Action: Sign the State lease proposal document Submitted By: Sybil Tate, Assistant County Manager 327 THE STATE OF NORTH CAROLINA SHALL NOT BE RESPONSIBLE FOR ANY EXPENSES INCURRED BY THE PROPOSER IN THE PREPARATION OF THIS PROPOSAL. PROPOSAL TO LEASE TO THE STATE OF NORTH CAROLINA - PO-28T 1. NAME OF LESSOR: Person County 2. LESSOR’S AGENT: INDICATE EACH LESSOR’S BUSINESS CLASSIFICATION AS APPLICABLE: A. PROPRIETORSHIP _B. PARTNERSHIP C. CORPORATION D. GOVERNMENTAL E. NON-PROFIT F. ***(HUB) HISTORICALLY UNDERUTILIZED BUSINESSES G. OTHER:__________ MAILING ADDRESS:304 South Morgan Street, Rm 212 MAILING ADDRESS CITY: Roxboro ZIP: 27573 CITY: ZIP: PHONE#: 336-597-1720 FAX# PHONE#: FAX#: E-MAIL:state@personcounty.net E-MAIL: 3. TOWER LOCATION: STREET ADDRESS CITY COUNTY ZIP CODE 7391 Semora Road Semora Person 27343 4. ATTACH SITE PLAN TO SCALE SHOWING THE HEIGHT , TYPE AND LOCATION OF TOWER 5. Ground lease ___0.6__________ acres or Tower Space 6. NEW EXISTING TOWER HEIGHT 280’ TYPE OF TOWER self-supported AGL If existing, height to be leased 7. OWNERSHIP/MAINTENANCE Provided by: Owned by: Maintained by: Tower Lessor Lessee Lessor Lessee Lessor Lessee Communications building Lessor Lessee Lessor Lessee Lessor Lessee Generator Lessor Lessee Lessor Lessee Lessor Lessee Road Lessor Lessee Lessor Lessee Lessor Lessee Utilities Lessor Lessee Lessor Lessee Lessor Lessee Other Lessor Lessee Lessor Lessee Lessor Lessee 8. LEASE RATE: $1 per year 9. LEASE TERM : 25 YEARS BEGINNING DATE: Execution of lease 10. RENEWAL OPTIONS, IF ANY: TERMS AND CONDITIONS: 30-day right to terminate clause; automatic 25-year renewal of initial term lease (unless State of NC elects not to renew and provides a 60-day written notice). NOTE: RATES THAT INCLUDE INDETERMINABLE PERCENTAGE INCREASES, SUCH AS UNCAPPED CPI INCREASES ETC., ARE NOT ACCEPTABLE DURING EITHER THE INITIAL TERM OR ANY RENEWAL PERIOD(S) 11. Will Lessor have equipment on tower? Yes No 12. Is Board approval required before execution of lease agreement? Yes ________________ No 13. ADDITIONAL INFORMATION 14. This proposal is made in compliance with the specifications furnished by the Department of Crime Control and Public Safety, Division of State Highway Patrol. I realize that the State reserves the right to reject this proposal for any reason it deems warranted. _________________________________________ Printed Name of Lessor/Lessor Agent and Title _________________________________________ _______________________ Signature of Lessor Date MAILING /DELIVERY INSTRUCTIONS Delivery Address If Delivered In Person: Director, State Property Office, Room 4055, Administration Building, 116 West Jones Street, Raleigh, North Carolina Mailing Address If Sent Through Mail Service: State Property Office, 1321 Mail Service Center, Raleigh, North Carolina 27699-1321 DEPARTMENT: AGENT: 328 329