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Durham County Community Health Assessment 2014

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Durham County Community Health Assessment 2014 Durham County Community Health Assessment 2014 Photos courtesy of RWJF Table of Contents Dedication…………………………………………………………………………….……….......i Acknowledgements……………………………………………………………………………....ii Writing Contributors………………………………………………………………….………....v Executive Summary………………………………………………………………………….…..1 Community Health Assessment Chapter 1. ..... Introduction……………………………………...…………………………..….10 Section 1.01 ……………………………..……………...…………………………..….11 (a) ........ Description of Durham County (b) ........ Overview (c) ........ Goals (d) ........ Organization of Document (e) ........ Health Data Sources (f) ......... Community Health Assessment Strengths and Opportunities Chapter 2. .... Community Priorities…………………………………..……..………………. 19 Section 2.01 …………………………...…………………………..….………...……...20 (a) ........ Survey methods (b) ........ Key Survey Findings (c) ........ Description of Community Input Sessions (d) ........ Key Health Data Findings (e) ........ Tracking Our Progress Chapter 3. .... Community Profile……………………………………………………………...35 Section 3.01 Demographics………………………..…….…….……………………………………...36 Section 3.02 Immigrant and refugee health……..……….….…..………………………..………...44 Section 3.03 Racial and ethnic disparities…..……………………………………………..………..57 Section 3.04 Durham facts and history……..……..………..……………………………..………...62 Section 3.05 Land use….……..………………………………………………………………………..66 Section 3.06 Built environment and transportation…….….………..……………………………..72 (a) ........ Sidewalks, bike lanes, and greenways Section 3.07 Parks and recreation…..……………………………..…..…………………………….83 Section 3.08 Faith and spirituality…..…….……………………………………………..…………..90 Appendices………………………………………………………………..……………….…..…97 Databook Chapter 4. .... Social, Economic, and Environmental Determinants of Health….………….98 Section 4.01 Poverty, economic security and toxic stress....……….….………………….……....99 Section 4.02 Housing, homelessness and food insecurity …….……………………………….…112 Section 4.03 Education…………….………………………………….……………….……..………128 Section 4.04 Access to health care, insurance, and information…...….…..…..………….....145 Section 4.05 Employment, income and worksite health………………….……...………......156 Section 4.06 Crime and safety…………………………………………………………..……………171 Section 4.07 Child care……..……..………………………….………….…….……….…....184 Chapter 5. ..... Health Promotion……………………………………………………………...195 Section 5.01 Physical activity…….…….……………….……………………………….…..196 Section 5.02 Nutrition and access to healthy foods……..…………….…………………….……212 Section 5.03 Tobacco………………………………………………………………………….…….. 232 Chapter 6...... Chronic Disease…………………………….………………………………….241 Section 6.01 Cancer………...………………………………………………………………….……..242 Section 6.02 Diabetes…………..…………………………………………………………………….257 Section 6.03 Heart Disease and Stroke………..………………………………………….………..270 Section 6.04 Obesity……………………………..……………………………………………………281 Section 6.05 Mental health and substance use and abuse……….………………………………295 Section 6.06 Asthma…………………………………………………..………………………………311 Section 6.07 Sickle Cell Disease………….…………………………..……………………………..324 Chapter 7. .... Reproductive Health………………………………………………………….331 Section 7.01 Pregnancy, Fertility, and Abortion…………..………………………………….…..332 Section 7.02 Access to Birth Control……………….……..…………..…………………………...344 Section 7.03 Prenatal Care………………………….…..…………………………………………..350 Section 7.04 Substance Use During and Around Pregnancy…………………………………....359 Section 7.05 Infant Mortality…….…………………………………………………………………..364 Chapter 8. .... Communicable Diseases……………...………………………………………372 Section 8.01 Vaccines and vaccine-preventable diseases…………………………………..…...373 Section 8.02 Infectious Diseases (not sexually transmitted) / TB……………………………....382 Section 8.03 Sexually transmitted infections…….…..…………………………………………….391 Section 8.04 Outbreaks……….….…………………………………………………………………...404 Chapter 9. .... Injury and Violence………….…………………………………………….....411 Section 9.01 Unintentional injuries…………..………….………………………………………....412 Section 9.02 Intimate Partner Violence……...……………………………………………....425 Section 9.03 Sexual violence…………………..…………………………………………………….433 Section 9.04 Child abuse and neglect……………………………………………………………....443 Section 9.05 Human trafficking………………..….……………………………………………...…451 Section 9.06 Homicide……………………….….………………………………………………..…..460 Section 9.07 Harassment and bullying…….………..…………………………………………..….466 Chapter 10. .. Oral Health……………….…………………………………………..……......476 Chapter 11. .. Environmental Health……...………….……………………………………...495 Section 11.01 Air quality…………………….……………………………………………………..….496 Section 11.02 Water quality……………….…………………………………………...….......502 Section 11.03 Lead poisoning………….…….…………………..……………………………………510 Section 11.04 Waste management…………..………………….…………………………….……....515 Section 11.05 Food safety……………………..……………….……….……………………….…….523 Chapter 12. .. Public Health Emergency Preparedness…………………………………..…530 Chapter 13. .. Older Adults and Adults with Disabilities ……………...……….…..…..…..541 Survey Data and Tools………………………………………..……………………………… 576 a) List of survey volunteers……………………………………………………………………576 b) Map of survey locations…………………………………………………………………….578 c) Durham County Community Health Assessment Survey, 2013 – English Version…….….579 d) Durham County Community Health Assessment Survey, 2013 – Spanish Version…….….595 e) Durham County Community Health Opinion Survey Results- English………………….…614 Durham County Community Health Opinion Survey Results- Spanish………………....…645 f) Community Listening Sessions Results…………………………………………………….678 DEDICATION This document is dedicated to the residents of Durham County. Thank you to all Durham County residents for your awareness of the community’s health strengths and needs and your willingness to share your thoughts and opinions. It is our intention for the ideas, projects and solutions that evolve from this process to be driven by and for members of the Durham County community. i ACKNOWLEDGEMENTS This assessment would not have been possible without the help and support of many individuals and groups of people who work and live in Durham County. The Durham Department of Public Health and the Partnership for a Healthy Durham would like to thank the following individuals and groups for their assistance during the course of this assessment: The Community Health Assessment Leadership Team members, Durham County Department of Public Health staff and the Partnership for a Healthy Durham partners and member agencies for their dedication and guidance in making the assessment a true community assessment. Gayle Harris, Health Director at the Durham County Health Department, for supporting the involvement of health department staff and her vision of addressing health disparities and the social determinants of health. Rachel Mills and Avilamar Bastidas Castillo, both with East Durham Children’s Imitative (EDCI) and the many volunteers who helped conduct the Community Health Opinion Surveys. See Appendix A for a list of the volunteers. The many volunteers who gave their time to facilitate the community listening sessions, especially Kenisha Bethea, Mel Downey-Piper, Debbie Royster, Rev. Mel Williams, Alyse Lopez-Salm and the Partnership for a Healthy Durham committee co-chairs. The community members who agreed to be surveyed or participated in a community listening session and provided valuable information about the health of Durham County. Duke Medicine Division of Community Health for financially supporting the Community Health Assessment and allocating a part-time staff person to assist with the health assessment. The City of Durham and the United Way of the Greater Triangle for financially supporting the Community Health Assessment Surveys. The Durham County Board of Health for their support and all of the elected officials who participated in the community listening sessions. Matt Simon at the North Carolina Institute for Public Health for his expertise creating a random sample of Durham households for the Community Health Opinion Survey, designing maps and training survey volunteers. Humberto Rodriguez with the Durham Health Innovations and Pilar Rocha and Colleen Blue with El Centro Hispano for their help in reaching out to the Spanish speaking community. Laura Henderson, University of North Carolina at Chapel Hill student. David Jolly, associate professor and Belinda Jones, instructor with the Department of Health Education at North Carolina Central University. 2014 Durham County Community Health Assessment ii Duke University, North Carolina Central University and University of North Carolina at Chapel Hill students. Alliance for Health 2014 Durham County Community Health Assessment iii The community health assessment process, including the coordination of the survey, this document and the listening sessions, were led by Erika Samoff, Mel Downey-Piper and Marissa Mortiboy at the Durham County Department of Public Health. The following individuals were instrumental in editing this document: •Erika Samoff, PhD Editors • Kenisha Bethea, MPH • Marissa Mortiboy, MPH Primary and •Gayle Harris, MPH, RN secondary • Michelle Lyn, MBA, MHA reviewers •Mel Downey‐Piper, MPH, CHES 2014 Durham County Community Health Assessment iv WRITING CONTRIBUTORS There were 80 individuals who contributed to this document, many of whom wrote more than one section. Thank you to the writers who put in many hours developing this document for the Durham County community. # Name of Section Name, Credentials Affiliation Intro Erika Samoff MPH, PhD Durham County Department 1.0 of Public Health, Partnership 2.0 for a Healthy Durham Coordinator Intro Mel Downey-Piper,
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