Duplin county
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AsthmaAsthma is a disease of the lungs that inflames and narrows the airway and often leads to repeated episodes of wheezing, chest tightness, shortness of breath, and early morning or nighttime coughing. Asthma most often starts in childhood; 25 million people in the US have asthma, 7 million of these are children.46 According to the 2011 North Carolina Behavioral Risk Factor Surveillance System, 13.2% of adults had ever been told by a health professional that they had asthma; 8.8% reported that they still had asthma. Percentages reporting current asthma are higher among women (11.6%) than men (5.9%) and among those with less than a high school education (11.5%) and household income less than $15,000 per year (16.6%).47 Due to changes in weighting techniques we are not able to compare percentages to earlier BRFSS reports. In 2010, 89 North Carolinians died due to asthma.48 While asthma impacts all North Carolinians, African Americans, Native Americans, women, the elderly, and children are among the groups most affected by asthma. There are many issues surrounding the causes and diagnosis of asthma. Asthma can be hard to diagnosis especially under the age of five years. Many factors impact the disease; poverty, lack of health care, literacy levels and environmental triggers, all play into the progression of the disease. The graph below compares the hospital discharge rates with a primary diagnosis of asthma for Duplin County and NC. While the hospital discharge rates for NC remained fairly stable until a decline between 2009 and 2010, the rates for Duplin County have declined steadily from 2006 to 2010. Since the 2008 CHA the incidence of hospitalizations for people with asthma declined as indicated in the graphs below. 2010 Comparison of Duplin County and NC Hospital Discharges with Primary Diagnosis of Asthma per 100,000 
Source: http://www.schs.state.nc.us/schs/data/databook Children who wheeze and have respiratory infections are at highest risk for asthma. The following graph shows hospital discharges with primary diagnosis of asthma for children age 0 – 14 years. In Duplin County, since 2008 there has been a substantial decline in asthma hospitalizations for children.
Source: http://www.schs.state.nc.us/schs/data/databook In the 2011 – 2012 end of year report school nurses reported a total of 774 students with asthma in Duplin County (501 elementary, 138 middle school, and 135 high school). Duplin County Schools provides an asthma education program for staff that reached 135, but not for students. There are 59 students using peak flow meters. School nurses reported that asthma treatments during school are an ever increasing problem. This includes both lack of knowledge on how to take medications as well as regular update to the asthma action plan. The Duplin County schools system has been 100% Tobacco Free since 2005.49 A factor that will impact both asthma and tobacco use is the elimination of the tobacco prevention initiative in the county schools. The TRU (tobacco reality unfiltered) program was funded by the state Health and Wellness Trust Fund was eliminated from the state budget in 2011. The health educators that facilitated in-school group education and peer community outreach on tobacco use are gone.
The following table shows the percent of kindergarten and 5th grade students in Duplin County and its peer counties with untreated tooth decay. In all five counties 20% or more of kindergarten students had untreated tooth decay in 2008 and between 4 – 9 percent of 5th graders. Untreated Tooth Decay among Kindergarten and 5th Grade Students
Source: http://www.ecu.edu/cs-dhs/chsrd/InstantAtlas/NC-Health-Data-Explorer.cfm Fluoridation of the water is a cost-effective preventive program and one measure that will impact dental health. The Duplin County’s water system is not fluoridated and there is little natural fluoride in the ground water. The Health Department continues to pursue the initiative to fluoridate the county water systems. The Health Department is currently working with the county water department and several municipalities to apply for a Golden Leaf foundation grant. The grant would provide funds to convert the county and area municipalities well heads to be able to deliver fluoride to the residents on those systems. The hospital reports that in 2010 children’s dental surgery was the number one operation scheduled at Vidant Duplin Hospital. In 2001, the Health Department obtained funding from the Kate B. Reynolds Foundation to start a mobile dental unit. The unit continues to operate and travels to the county’s public elementary schools and some of the middle schools to provide care to children through 18 years of age. During the summer months the unit is located at the DCHD and provides serves to children and some limited services to adults. The unit accepts all forms of insurance, Medicaid and provides a sliding fee scale for self-pay clients.
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