HEALTH PROFILE

Health and the influences on health are multi-faceted. In this section we will examine various indicators and influences on the health of the community of Fuquay-Varina, which include morbidity (disease and disability) and mortality (death); birth and pregnancy outcomes; and aspects of social health, school health, and quality of life. Throughout this section, where data specific to Fuquay-Varina were not available, inferences will be made based upon county and state level data. The Fuquay-Varina zip code area and Wake County are relatively similar in terms of racial makeup, except that Wake County has a slightly higher proportion of minorities overall and Fuquay-Varina a higher proportion of Latinos. With respect to age, in Wake County, 64.6% of the population is aged 20-64 compared to 59.8% in Fuquay-Varina (Fuquay-Varina Area Chamber of Commerce, 1999c).

In this section, morbidity and mortality data for Wake County and North Carolina are reported as rate per 100,000 persons, whereas data for Fuquay-Varina are reported as frequencies and percentages. Therefore, our ability to make true comparisons between the town and the other two levels is accordingly limited. Furthermore, our primary data source, the North Carolina Center for Health Statistics, categorizes statistics by race in two categories- white and minority. Thus, we are unable to extract implications for specific minority groups, such as African-Americans, Latinos, and Asians.

The reported communicable diseases are categorized into three sections: sexually transmitted diseases (STDs), childhood diseases, and other diseases.

Sexually Transmitted Diseases

Of the reported STDs in Fuquay-Varina, gonorrhea was reported most frequently, followed by chlamydia in 1998. In fact, gonorrhea and chlamydia cases accounted for 80% of all the communicable diseases reported in the area. This pattern is notable at the state and county levels as well (Table 5.1). At the state and county levels for all ages, minority males had the highest overall rates of reported STDs, with the exception of chlamydia, for which minority women had the highest rate. Among white males and females, gonorrhea and chlamydia rates were the highest of all STD infections. For persons under twenty, the highest rate of STD infection was found for chlamydia in minority women 15-19 years of age (Table 5.2). Other rates among this group mimic those of the general population. No new cases of Acquired Immunodeficiency Syndrome (AIDS) were reported for 1998 in Fuquay-Varina. Similarly, there were no new reported cases of AIDS at the county level among the less-than-twenty-years-old group.

Source: North Carolina Center for Health Statistics, 1998

Source: North Carolina Center for Health Statistics, 1998
Note. ... Indicates no reported cases, or rate is not significant

Childhood Diseases Preventable by Immunization

Immunizations are a relatively safe, effective, and cost-effective disease prevention measure. Currently, the recommended vaccination schedule in the United States for infants and children includes four doses of diptheria-pertussis-tetanus (DPT) vaccine; three doses each of polio, Haemophilus influenzae type b (Hib) and hepatitis B vaccines; and one dose each of vaccine against measles-mumps-rubella (MMR) and chicken pox by two years of age (http://www.cdc.gov/nip/, 1999). Vaccination coverage rates are available only at the national and state levels.

As demonstrated in Table 5.3, immunization coverage rates are higher in North Carolina than in the United States overall. The comparative incidence of whooping cough rates in the United States (2.9), North Carolina (1.5), and Wake County (1.6) in 1998 demonstrate the implications of high vaccination coverage. In Fuquay-Varina, no childhood vaccine-preventable diseases were reported in 1998.

Source: CDC, National Immunization Program,
http://www.cdc.gov/nip/

Other Diseases

Other cases of communicable diseases reported in Fuquay-Varina in 1998 were as follows: salmonellosis (n=5), hepatitis A (n=3), viral meningitis (n=2), tuberculosis (n=2), food borne disease (n=1), and hepatitis B carrier (n=1). At the county and state levels, minority males had the highest rates of communicable disease, followed by minority females. Viral meningitis was reported at a significantly higher rate for Wake County than for the State, and in both cases, minority males and minority females had the highest rates for these diseases. Overall tuberculosis (TB) rates were comparable for the county (7.1) and state levels (6.6). At the county level, the minority male rate was the highest (22.3), followed by the minority female rate (21.4). Among white males and females, the TB rates in Wake County were 4.1 and 1.3, respectively. Similarly, the minority male rate of TB was the highest at the state level (25.4), followed by the minority female rate (10.5), white males (4.7) and white females (1.6). The highest rate of Hepatitis A was reported among white males at both the county and state levels, with the overall rate at the county level being somewhat higher than at the state level.

Overall, chronic illnesses such as diseases of the heart were the primary cause of death among all groups in Fuquay-Varina in 1998, followed by a form of cancer (malignant neoplasms) and cerebrovascular disease (for example, stroke). There were no deaths from AIDS or homicide in Fuquay-Varina (Table 5.4).

Source: North Carolina Center for Health Statistics, 1998

Fuquay-Varina reflects similarly to Wake County and North Carolina, in that the primary causes of death among both sex and race/ethnic groups were chronic diseases (diseases of the heart, cancer and cerebrovascular diseases). However, the overall rates for these causes of death differed greatly between Wake County and North Carolina, as shown in Table 5.5.

Source: North Carolina Center for Health Statistics, 1998

In Wake County and in North Carolina, there are important differences in mortality rates between whites and minorities. Minority males and females showed significantly higher mortality rates for AIDS and homicide in 1998. In Wake County, the rates for homicide were 14.3 per 100,000 in minority males and minority females. This compares with 5 and 1.3 (both per 100,000) for white males and females, respectively. In North Carolina, the homicide rates were as follows (all per 100,000): 36.5 among minority males, 8.4 among minority females, 7.2 among white males and 2.4 among white females.

In the State, minorities face a higher risk of death due to AIDS than whites. In Wake County, mortality rates for AIDS (per 100,000) were 30.2 and 8.6 among minority males and females, respectively, compared with 4.1 for white males and 0 for white females. In the State, rates (per 100,000) were 26.8 in minority males, 11.5 in minority females, 2.9 in white males, and 0.4 in white females.

As shown in Table 5.6, the highest mortality rate among the 15-19 year old age group for both the County and the State was due to injuries. Minority males were found to have the highest rate of death due to injury, followed by white males, white females and minority females, respectively. Deaths from injury among the 10-14 year old age group were also significant when compared to deaths from other causes in that age group. Similar to deaths by injury, deaths from homicide were highest among the 15-19 year old age group at the county and state levels. Compared to the overall mortality rates (per 100,000) for AIDS, 5.7 for North Carolina and 5.9 for Wake County, AIDS deaths among children were low.

Source: North Carolina Center for Health Statistics, 1998
Note. ... Indicates no reported cases, or rate is not significant

A gender-race disparity is seen in the morbidity and mortality data overall. Further investigation is warranted to address these disparities.

Births and Pregnancy Outcomes

According to the North Carolina Center for Health Statistics, in 1998, there were 9,031 births to women residing in Wake County, accounting for 8.1% of all North Carolina resident births. At the state and county levels, roughly three-quarters of births were to whites and the remaining one-quarter were to minorities (North Carolina Center for Health Statistics, 1998). Fuquay-Varina resident births represented 2% (n=170) of all Wake County resident births; 75.3% (n=128) of births were to whites and 24.7% (n=42) to minorities (North Carolina Center for Health Statistics, 1998).

Teen pregnancy rates in North Carolina in 1997 reflected a 13% percent decline from 6 years ago (CDC, 1999). The Wake County rate is 59.7 per 1,000 teenagers. In Fuquay-Varina, there were 16 births to young women ages 15-19, accounting for 9.4% of all resident births. Abortion rates are unavailable for Fuquay-Varina; however, according to the most recent data (1997), 26.9% of pregnant females ages 15-19 in Wake County terminated a pregnancy.

Infant health and pregnancy-related indicators in Fuquay-Varina were similar to those of Wake County. For example, 87.2% (n=7873) of women in Wake County initiated prenatal care during the first trimester of pregnancy compared to 87.1% (n=148) of women in Fuquay-Varina (North Carolina Center for Health Statistics, 1998). Moreover, more than 99% (n=8962) of women in the County and all women in Fuquay-Varina received some prenatal care. There were no significant differences between races in initiation of prenatal care (North Carolina Center for Health Statistics, 1998).

A number of high-risk behaviors, such as alcohol consumption and smoking during pregnancy, contribute to poor birth outcomes. Unfortunately both of these behaviors are under-reported in birth certificate data; so, it is difficult to obtain a true picture of the impact of these behaviors on pregnancy outcomes. Out of 170 live births to women in Wake County, 8.2% (n=14) of women reported smoking during pregnancy compared to 6.4% (n=575) countywide (North Carolina Center for Health Statistics, 1998). No women in Fuquay-Varina reported smoking during pregnancy and 1.1% (n=1) reported alcohol consumption during pregnancy (North Carolina Center for Health Statistics, 1998).

Birth outcomes can be an indicator of the health of communities. Outcomes such as low birthweight (<2500 grams) and premature delivery (delivery at <36 weeks gestation) are associated with high infant morbidity and infant mortality (death before age 1). Data for singular years can be less stable than rates calculated over several years; so birth outcome data will be presented for five-year intervals when available. The overall infant mortality rate in North Carolina for the years 1994-1998 was 9.4 infant deaths per 1,000 deliveries compared to 8.5 in Wake County (North Carolina Center for Health Statistics, 1998). The rate for whites in North Carolina and Wake County were 6.3 and 6.4, respectively, and were 16.3 for minorities at the state and county levels in 1998 (North Carolina Center for Health Statistics, 1998). United States rates are presented by ethnic group and were 7.2 per 1,000 overall, 6.1 for whites, 14.0 for blacks, and 6.0 for Hispanics (CDC, 1999). An obvious racial disparity exists at the national, state, and county levels for infant mortality, as well as for low birth weight. In 1998, 7.8% (n=9870) of all North Carolina resident births were low birth weight babies (North Carolina Center for Health Statistics, 1998). Of these babies, 56.5% (n=5578) were born to whites and 43.5% (n=4292) to minorities. Data on premature delivery were not available at the county, state or national levels.

Child Abuse and Neglect

The Child Protective Services (CPS) division of Wake County Human Services handles reports of child abuse and neglect for the county. An examination of countywide data allows us to get some idea of the trends in reports of abuse and neglect (J. Ray, personal communication, November 18, 1999). In this section, we will define children as people of ages 0-18.

According to CPS, most cases of abuse or neglect are reported by school staff, mental health providers and County case-workers (J. Ray, personal communication, November 18, 1999). There were 3,491 reported cases of child abuse or neglect involving 7,588 children in Wake County during the 1998-99 school year. Of these, 469 cases were substantiated by investigators. In comparison, there were 2,691 reported cases involving 5,891 children, and 497 substantiated cases during the 1997-98 school year. In 1997-98, 49 out of 497 cases were abuse, 2 out of 497 were dependency cases, and 446 out of 497 were neglect (J. Ray, personal communication, November 18, 1999). The Fuquay-Varina Police Department reported that they investigated approximately 12 child abuse cases in 1999 (G. McNeill, personal communication, April 20, 2000).

School nurses serve students enrolled in Wake County Public Schools, but they are employees of Wake County Human Services. Each school nurse serves 3 to 4 schools; therefore, schools do not have a nurse everyday. Data are available for 21 schools in the Southern Regional area of Wake County, including Fuquay-Varina, for the 1997-1998 school year.

Health support services include screenings, counseling, services for children with chronic diseases, and health consultations with parents, teachers, and other school staff. Some common topics addressed with students included family planning (n=85), hygiene (n=110), nutrition (n=100), pregnancy (n=172), sexually transmitted disease (n=47), substance abuse (n=11), and "other" topics (n=4400). The most common screening services provided were vision rescreens (n=2350), health assessments of special problems (n=4352), and student health history reviews (n=2093) (Wake County Human Services, 1998).

Nurses addressed AIDS, health promotion, first aid, chronic disease, the nurse's role, and other topics through health education to school staff. Health education to parents occurred less frequently than to staff and students. The majority of education provided to parents was on the topic of the nurse's role, with 3,749 parents receiving this information. Nurses made 113 home visits (Wake County Human Services, 1998).

School health reports provide information on the number and qualifications of nursing staff serving each school; school health policies; medication administration (meds) and provision of services breakdown; and incidence of various types of illness, injury, or emergency occurring in each school (Table 5.7).

Source: End of Year Report: School Health Nursing and Program Summary, 1999

Wake County Human Services and Wake County Public Schools have joined forces to create the Partnership for School Success, a pilot project that has two phases. One focuses on learning from research-based models and the other involves a realignment of resources (Partnership for School Success: School Age Committee, 1999). The school district has set a goal to have 95% of students performing at or above grade level by 2003. In 1997-1998, 18% of students were performing below grade level. The Partnership has dedicated itself to improving the educational outcomes of students as well as impacting poverty and improving the mental, physical, and behavioral health of children and families (Partnership for School Success: School Age Committee, 1999). Ultimately, the committee seeks to form a partnership between human services and the public school system, which will serve families and students on multiple levels, representing a new and more holistic approach to improving school success.

In Wake County in 1997, there was one primary care physician for every 1,101 residents; one primary care physician plus extender (nurse practitioner or physician assistant) for every 1,989 residents, one registered nurse for every 99 residents; and one dentist for every 1,746 residents (North Carolina Center for Health Statistics, 1997). There was a ratio of 419 people for every hospital bed, and the hospital use rate was 87% of capacity (North Carolina Center for Health Statistics, 1997). In comparison, the most recent data (1995) for North Carolina show there was one primary care physician for every 467 people and a nurse for every 122 people in the state (North Carolina Center for Health Statistics, 1997).

In 1997, 8.8% of the Wake County population was Medicaid-eligible (low-income eligibility-based insurance), and the Medicaid spending per capita was $276.00 (North Carolina Center for Health Statistics, 1997). Of children ages 0-4, 20.9% of Wake County children used the County health department in 1997 for child health, child service coordination, or other services (North Carolina Center for Health Statistics, 1997).

Various health insurance data were available for the State, although the most recent year varied by the type of data. Approximately 16% (n=1,160,000) of North Carolinians were without health insurance in 1996 (North Carolina Center for Health Statistics, 1997). In 1997, approximately 14.6% (n=1,070,000) of the population was enrolled in a Health Maintenance Organization (North Carolina Center for Health Statistics, 1997). In 1995, approximately 1,025,000 received Medicare Insurance (for people ages 65 and over), with each recipient receiving an average of $3,943. Another 1,130,000 were receiving Medicaid at an average of $3,255 per recipient (North Carolina Center for Health Statistics, 1997).

Based upon a phone conversation with the Wake County Emergency Medical Services (EMS), a local volunteer rescue squad and Wake County Emergency Medical Services both serve Fuquay-Varina locally. Four acute care hospitals are available in Wake County, three in Raleigh and one in Cary. The hospitals in Raleigh inlcude Wake Medical Center (with trauma services), Rex Hospital, and Raleigh Community Hospital; Western Wake Hospital is in Cary (anonymous personal communication, December 3, 1999).

WakeMed has a rehabilitation facility in Fuquay-Varina to help with the, "treatment of patients recovering from stroke, head/spinal cord injuries, brain injuries, arthritis, and neuromuscular disorders" (WakeMed, 1999). This facility serves over 1,200 patients a year (WakeMed, 1999).

The Southern Regional Center (SRC) in Fuquay-Varina is a regional branch of Wake County Human Services and a pilot site for future facilities in Wake County. Health services include mental health and substance abuse treatment, provision of school health personnel, clinics for women's and children's health, HIV/STD testing, maternity care, environmental health, crisis intervention, and economic assistance through Medicaid insurance (Southern Regional Center, 1999). Other services available include job search and work permits, food stamp case management, revenue collections, and registration of deeds for marriage licenses and title searches. Bilingual (Spanish/English) staff is also at the facility to serve the needs of those who do not speak English as their first language.

The Fuquay-Varina Community Center is run by the Parks, Recreation, and Cultural Resources Department, and provides instructional classes for all ages in a wide variety of health and wellness areas, such as physical fitness, arts and crafts, dance, emergency rescue techniques, and martial arts (Town of Fuquay-Varina, 1999).

The Pine Acres Community Center serves a part of the town which is primarily African-American. Services include an after-school program that focuses on learning, Meals on Wheels and elder daycare. This Center is also a community-meeting place.

Mental health and substance abuse are topics of concern for many communities nationwide. It is estimated that 99,000 persons in North Carolina have severe and persistent mental illness (North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services [MH/DD/SAS], 1999). The state has a long history of caring for those suffering with mental illness and is able to provide statewide community-based care as well as inpatient care. Most communities in the state have broad-based coalitions in place to address concerns about substance abuse (North Carolina Division of MH/DD/SAS, 1999).

The North Carolina Division of the MH/DD/SAS (1999) claimed to have made notable advances in mental health services available for children. For example, the Willie M. Program in North Carolina serves more than 1,600 children and adolescents with violent behavior and/or serious emotional, mental or neurological disabilities. The proportion of children served by the program in the state has increased from 59.4 per 100,000 youth population in 1982 to 84.7 per 100,000 in 1997. The average age of the clients is 14.5 years old. Eighty percent of them are males and slightly more than half of them are African-American. However, the North Carolina Division of MH/DD/SAS (1999) notes that fifteen percent or more of children served in their area programs have unmet mental health needs. Furthermore, they estimate up to 100,000 children who require professional interventions in North Carolina are unserved .

Locally, the Wake County Public School System offers psychological services to its students. The school system employs 46.5 psychologists, including a crisis intervention specialist and a behaviorally/emotionally handicapped specialist (WCPSS, 1997).

The results of the Center for Disease Control's Youth Risk Behavior Survey may be used to gain insight into substance abuse and other high-risk behaviors involving teens, including suicide attempts. According to the 1997 national survey, in which 16,262 questionnaires were completed by students in 151 schools, male students were generally more likely than females to use smokeless tobacco (9.0% compared to 4.0%, respectively), alcohol (7.2% compared to 3.6%, respectively), and marijuana (9.0% compared to 4.1%, respectively). Males were also more likely than females to acquire illegal drugs on school property (37.4% compared to 24.7%, respectively) (CDC, 1998). Hispanic students were, overall, more likely than white students to be involved with alcohol use (8.2% compared to 4.8%, respectively), marijuana use (10.4% compared to 5.8%, respectively), or acquiring illegal drugs on school property (41.1% compared to 31.0%, respectively) (CDC, 1998). A clear gender and race disparity is evident at the national level for suicidal ideation and tobacco and drug involvement on school property. Among high school students in North Carolina, the prevalence or rate of use and/or abuse of all substances included in the survey was higher among males than females. However, females showed higher rates of suicidal ideations and behaviors than did males (CDC, 1998).

According to the same survey, 35.8% of high-school students in North Carolina reported current cigarette use, 42.7% reported current alcohol use, 22.9% reported episodic heavy drinking, and 24.9% reported current marijuana use. Current use is defined as using the substance at lease once within the 30 days prior to the study, and episodic heavy drinking is defined as at least five drinks on one occasion within the 30 days prior to the study (CDC, 1998)

The total criminal offenses in Fuquay-Varina for 1999 as of October 1999 were 1194 (Fuquay-Varina Police Department, 1999). The most common offenses were criminal damage (n=166, 13.9%), and larceny (n=395, 33.1%) (Fuquay-Varina Police Department, 1999). There were 45 arrests on drug charges in Fuquay-Varina in 1999 (G. McNeill, personal communication, April 20, 2000). There were 325 arrests on file for the year, as of October 1999. The overwhelming majority of the arrests were adult males (249, 76.6% of total arrests). Male to female arrests occur at a ratio of approximately 4:1 (Fuquay-Varina Police Department, 1999).

Juvenile crime statistics for Wake County and North Carolina were available for 1997 and 1998. Total juvenile (under age 18) arrests in Wake County in 1997 were 3,427 compared to 3,261 in 1998, a decrease of 4.8%. In the State, juvenile arrests totaled 58,340 in 1997 and 57,670 in 1998, a decrease of 1.1% (NC State Gov, 1998). The percentage of State juvenile arrests that were in Wake County for the years 1997 and 1998 were 5.6% and 5.7%, respectively (NC State Gov, 1998). As of October 1999, Fuquay-Varina had not had any juvenile arrests for the year (Fuquay-Varina Police Department, 1999).

Source: Crime in North Carolina - 1998, NC State Gov.

The top 3 most common juvenile arrests statewide in 1998 were the same as those for the County: larceny (17.5%), drug possession/intent to sell (7.7%), and simple assault (14.1%) (NC State Gov, 1998). In comparing Wake County percentages to the State in 1998, the difference in juvenile drug arrests was greatest among the top 3 categories. In 1998, the top 3 criminal offenses among adults were driving while intoxicated (DWI), drug possession/intent to sell, and simple assault.

In this section, we have presented information on several salient aspects of health, including morbidity and mortality, birth and pregnancy outcomes, child abuse and neglect, school health, health resources, crime, mental health and substance abuse. There are similarities and differences in the health of Fuquay-Varina when comparing the town to the county, state, and nation. For both morbidity and mortality at the county and state levels, a general disparity was evident between minorities and whites. Similarly, this difference is also noted at the national, state, and county levels for infant mortality and low birth weight. Consistently higher rates of STD's at the county and state levels, particularly gonorrhea and chlamydia, were noted when compared to other communicable diseases.

Regarding child abuse and neglect in Wake County, between the 1997-98 school year and the 1998-99 school year, there was an increase in the number of reported cases of abuse and neglect. However there was a reduction in the number of substantiated cases. The health resources data show that most people had health insurance in 1996 and hospital facilities were adequate to serve the population size.

For any health-related intervention in Fuquay-Varina, it would be wise to first consider the comparisons and contrasts discussed in order to strategically tailor the program according to the town's specific needs.

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