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COMMUNITY ASSESSMENT
COMPREHENSIVE REVIEW OF SUBSTANCE USE
IN CABARRUS COUNTY
2014-2015
Healthy Cabarrus Substance Use Coalition
ii
VISION
To build a healthy, resilient community where all residents have the resources and opportunities to succeed and live a safe and healthy lifestyle.
MISSION
To mobilize community partners to build a healthier community by reducing substance use and its effects, particularly among youth.
iii
Table of Contents
EXECUTIVE SUMMARY .............................................................................................................................. 5
I. COMMUNITY DESCRIPTION ................................................................................................................. 8
Define the Community ......................................................................................................................... 8
The Community Demographically...................................................................................................... 10
The Community Geographically ......................................................................................................... 11
II. COMMUNITY NEEDS ........................................................................................................................... 12
Data Collection Methods Used .......................................................................................................... 12
Quantitative ................................................................................................................................. 12
Qualitative .................................................................................................................................... 12
Environmental Scans .................................................................................................................... 13
Results of Community Data Collection .............................................................................................. 15
Consequences .............................................................................................................................. 15
Problem Behaviors ....................................................................................................................... 17
Root Causes and Local Conditions ............................................................................................... 20
III. COMMUNITY RESOURCES ................................................................................................................ 26
People ................................................................................................................................................. 26
Facilities, Equipment, and Supplies ................................................................................................... 27
Organizations and Prevention Programs ........................................................................................... 27
Systems and Infrastructure ................................................................................................................ 28
Laws and Policies ................................................................................................................................ 28
Funding ............................................................................................................................................... 29
Gaps in Resources ............................................................................................................................... 29
IV. COMMUNITY HISTORY ...................................................................................................................... 30
Historical Origins of Related Issues .................................................................................................... 31
History of Organizing for Community Improvement ........................................................................ 31
History of Organizing on Related Issues ............................................................................................ 32
V. PROBLEM/GOAL STATEMENT ........................................................................................................... 33
Identified Problem .............................................................................................................................. 33
Goal Statement ................................................................................................................................... 33
ATTACHMENT A - Cabarrus Survey Instruments ................................................................................ 35
ATTACHMENT B - Logic Model .............................................................................................................. 42
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Executive Summary Cabarrus County is home to 192,103 residents. In addition to being one of the largest counties in the state, the
County accommodates many tourists at any given time. Located in south central North Carolina, Cabarrus
County spans an area of 364.39 square miles and is bordered by Stanly, Union, Mecklenburg, Iredell, and Rowan
Counties. It is the state’s 11th most populous county and 7th fastest growing county.
As our population is growing, so are the needs
of our community. The Healthy Cabarrus
Substance Use Coalition was developed in 2012
in response to the identification of substance
use as a priority issue in the 2012 Community
Needs Assessment. The Healthy Cabarrus
Substance Use Coalition includes representatives from mental health, public health, healthcare, education,
youth, community members, faith-based organizations, law enforcement, and others. The 2014- Cabarrus
County Community Assessment on Youth Substance Use is a vital support in defining and prioritizing the
community’s needs and the Coalition’s goals and objectives.
Elements of the needs assessment include both qualitative and quantitative data collected from student and
adult surveys on prescription medication use, one-on-one interviews, focus groups, environmental scans, and
local newspaper articles. Existing data was pulled from sources including law enforcement reports, EMS
reports, NC DETECT, The North Carolina Behavioral Risk Factor Surveillance System, and reports on number of
deaths related to various drugs in Cabarrus County. In addition, the Coalition collected primary data using the
2015 Teen Prescription Medication Survey, 2015 Adult Prescription Medication Survey, and the 2009 and 2014
Cabarrus County Youth Risk Behavior Surveys (CYRBS). The results of the assessment are summarized below:
Alcohol Alcohol, marijuana, and prescription medication are the three substances most
widely used in Cabarrus County. The 2014 CYRBS assessed lifetime use of alcohol,
past 30 day use of alcohol, alcohol use on school property, and binge drinking.
Among students who reported consuming alcohol in the past 30 days, 12% of high
school students and 9% of middle school students consumed alcohol on school
property. Additionally, 40% of high school students and 17% of middle school
students who had consumed alcohol in the past 30 days reported binge drinking.
School social workers and counselors who were asked to assess substance use in
their schools most frequently reported alcohol as being the most common
substance use issue (88% of respondents). 43% of one-on-one interviewees
reported that they perceived alcohol as a substance that widely affects our
community.
The Healthy Cabarrus Substance Use Coalition was developed in 2012 in response to the identification of substance use as a priority issue in the 2012 Community Needs Assessment.
6
Marijuana The CYRBS shows that lifetime use of marijuana has decreased from 36% in 2009
to 26% in 2014. Additionally, among surveyed students, 52% of middle school
students and 80% of high school students agreed that kids think that marijuana is
natural and therefore not harmful. 65% of middle school students and 90% of high
school students agreed that kids believe that marijuana helps you relax (CYRBS,
2014).The Kannapolis City Police Department reported 34 school arrests for
marijuana between 2010 and 2013. The number of arrests has declined from 11 in
2010 to 6 in 2013.
Prescription Medication Between 1999 and 2010, Cabarrus County witnessed an 850% increase in the
number of unintentional medication or drug-related poisoning deaths from 2 to
19. In 2010, there were 19 unintentional medication or drug-related poisoning
deaths, 15 of which were caused by prescription opioids. While mortality has
declined since it peaked in 2005, the number of deaths in 2011 is still far higher
than it was in the early 2000s. Compared to the state overall, Cabarrus County had
a significantly higher rate of unintentional medication and drug-related poisoning
emergency department visits in 2012 (125.7 per 100,000 vs. 87.3 per 100,000)
(Community Care of North Carolina). The Cabarrus County Sheriff’s Office
reported 45 cases of larceny related to prescription drugs in 2013, a significant
increase from 33 incidents in 2012. When respondents from one-on-one
interviews were asked what substance they perceive most widely affecting their
community, 75% responded with prescription drugs. The Medication Safety
Survey found that 25% of respondents revealed that they had painkillers such as
OxyContin, Percocet, or Hydrocodone in their home. The same sample also
reported that 44% store their prescriptions in an unlocked cabinet or drawer. The
Teen Medication survey revealed that 63.2% of teens report that prescription
medications are fairly easy or very easy to get. The same survey revealed that
15.3% of high school students reported that they had used prescribed medications
after the prescribed time frame for other injuries, pain, or for nonmedical
purposes.
Prioritization Process Although alcohol and marijuana are more frequently used among adolescents, the coalition decided to pursue
prescription drug misuse due to the more severe consequences associated with prescription drugs and the
rapid rise in medication-related overdoses. The majority of drug overdose deaths in Cabarrus County are a
result of prescription opioids. Furthermore, there have been numerous arrests related to thefts and sales of
prescription drugs in recent years. Based on the strength and diversity of the data received, the Coalition
identified the problem of prescription drug misuse among high school students in Cabarrus County as its top
priority. Through the use of a logic model, the Coalition has identified two root causes: availability of
prescription drugs and favorable youth attitudes toward prescription drug use. The Coalition also identified
two data driven local conditions that highlight key issues in our community: 1) medications are available to
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youth in the home due to families not storing and disposing of medications properly and 2) teens use
prescription medications after school and on weekends to deal with stress/problems.
Goals Through the use of strategic and action plans, policy advocacy, and evaluation plan, the Healthy Cabarrus
Substance Use Coalition is equipped and dedicated to reaching the following goals:
Long Term Objective: To reduce the percent of all high school students (9th-12th) that have ever taken prescription
medications without a doctor’s order from 11.2% in 2014 to 10% by 2020 as measured by the Cabarrus
Youth Substance Use Survey.
Intermediate Objectives:
1. To reduce the percentage of teens that report that prescription medications are fairly easy or very
easy to get from 63% in 2015 to 58% in 2017 as measured by the Teen Medication Survey
2. To decrease the percent of teens that believe there is no risk to slight risk associated with trying
someone else’s prescription medications once or twice from 32.6% in 2014 to 27% in 2017 as
measured by the Teen Medication Survey.
Short Term Objectives:
1. To increase the percentage of people that dispose prescription medication properly from 14% in
2015 to 16% in 2017 as measured by the Teen and Adult Medication Survey
2. To decrease the percent of teens that agree or strongly agree that teens misuse prescription
medications to help them deal with problems from 62% in 2015 to 56% in 2017 as measured by the
Teen Medication Survey.
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COMMUNITY ASSESSMENT
Coalition Name: Healthy Cabarrus Substance Use Coalition
I. COMMUNITY DESCRIPTION Define the Community
The Healthy Cabarrus Substance Use Coalition serves all of Cabarrus County, a thriving urban community with
a population of 192,103. It is the state’s 11th most populous county and 7th fastest growing county. The number
of people living in Cabarrus County increased by 7.92 percent between 2010 and 2014. Although primarily
urban, Cabarrus County is geographically diverse. It has a significant number of rural pockets as well as three
towns and two cities (Concord, Harrisburg, Kannapolis, Midland, and Mount Pleasant). Concord is the state’s
12th most populous city, while Kannapolis is the state’s 20th. To accommodate the youth in our community,
there are two school districts, Kannapolis City Schools and Cabarrus County Schools. Within the community,
there are three law enforcement agencies: Kannapolis Police Department, Concord Police Department, and
Cabarrus County Sheriff’s Office. In addition, Cabarrus County has several healthcare agencies including
Carolinas Medical Center-Northeast, Cabarrus Health Alliance, the Community Free Clinic, and Cabarrus Rowan
Community Health Centers.
Places of Interest
In addition to being one of the largest counties in the
state, Cabarrus County accommodates many tourists
at any given time. Self-branded as the Center of
American Motorsports, the County is well known for
its NASCAR industry, which includes the Charlotte
Motor Speedway and several major race shops. Other
popular tourist attractions include Concord Mills Mall
(the largest tourist attraction in North Carolina), Sea
Life Aquarium, Reed Gold Mine, and Great Wolf
Lodge.
Communities within Our Community
There are numerous neighborhoods and other small communities within Cabarrus County. For example, the
City of Concord offers a Partnerships for Stronger Neighborhoods program, which formally recognizes 52
neighborhood associations and homeowner’s associations in Concord alone. Similarly, the Town of Harrisburg
recognizes 32 neighborhoods. Additionally, the Towns of Mount Pleasant, Midland and the City of Kannapolis
all have their own unique cultures and communities.
The town seat of Cabarrus County is Concord. Historically, the City of Concord was recognized as a flourishing
textile community with easy access to the railroads. The railroads allowed for the quick transport of products,
making Concord a desirable place to live. Since the 1800’s the population has steadily increased. The North
Carolina State Demographer's Office estimates that the current population is 80,386 and the city is 60.06
square miles. Due to the size, Concord is broken into two zip codes. In addition, Concord has their own police
department and is a part of Cabarrus County schools.
9
Another city that makes up Cabarrus County is the City of Kannapolis. Kannapolis is located northwest of
Concord. The 2010 census estimates the population at 42,625 (96% urban, 4% rural), which makes Kannapolis
the 20th largest city in North Carolina. The city is comprised of two zip codes. Additionally, Kannapolis has their
own police department and school system, Kannapolis Police Department and Kannapolis City Schools.
Kannapolis is home to the North Carolina Research Campus, the Public Health Authority of Cabarrus County
(Cabarrus Health Alliance), and other companies including General Mills, Sensory Spectrum, Carolinas Medical
Center-Kannapolis, and Ei Solutions. Other nutrition, healthcare, and food technology organizations have
joined the Kannapolis business community in recent years as well.
In addition to larger cities, Cabarrus County is also home to small towns. The Town of Harrisburg has a total
area of 6.2 square miles, all of it land according to the United States Census Bureau. The town borders North
Mecklenburg County. North Carolina Highway 49, an important corridor for traffic, runs through the center of
town. The census estimates that Harrisburg has 13,788 residents and over thirty two neighborhoods. Instead
of having its own police department, the town contracts Deputies from the Cabarrus County Sheriff’s Office.
Harrisburg is the wealthiest jurisdiction in Cabarrus County.
The Town of Midland began as a railroad town in 1913. A community named Garmon existed in the area prior
to Midland’s establishment and appears on an 1864 map of North Carolina. Midland is the home of Reed Gold
Mine, where the first authenticated discovery of gold occurred in the United States. Midland is a small, rural
community with 3,073 people as of 2010.
In the early 1800’s, The Town of Mount Pleasant was the "comfort station" for wagons that traveled from
Concord to Salisbury. The population of the rural community is currently 1,686 citizens. The Town is planning
for and expecting growth in the community given the pending completion of major highways and continued
growth in the Charlotte region.
Table 1: Median Household Income1,2,3 2009-2013
1 Midland, North Carolina (NC) income map, earnings map, and wages data. City data. 2009. Available at:
http://www.city-data.com/income/income-Midland-North-Carolina.html#ixzz3W9b3z01P. Accessed on January 12, 2015. 2 Mount Pleasant, North Carolina (NC) income map, earnings map, and wages data. City data. 2009. Available at:
http://www.city-data.com/income/income-Mount-Pleasant-North-Carolina.html#ixzz3W9c3O3lf. Accessed on January
12, 2015. 3 State and County QuickFacts. U.S. Census Bureau. 31-Mar-2015. Available at:
http://quickfacts.census.gov/qfd/states/37/3735200.html. Accessed January 12, 2015.
Town Income
Concord $53,337
Harrisburg $81,808
Kannapolis $39,275
Midland (2009) $54,065
Mount Pleasant (2009) $47,763
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School Systems Cabarrus County is home to two school districts: Kannapolis City Schools (KCS) and Cabarrus County Schools
(CCS). KCS serves 5,462 students across 9 schools, including 1 pre-Kindergarten school, 5 elementary schools
(K-4), 1 intermediate school (5-6), 1 middle school (7-8), and 1 high school (9-12). Cabarrus County Schools is a
much larger district, serving nearly 30,000 students across 39 schools.
Table 2: Demographics by School System4,5
Percent Free/Reduced Lunch
Percent African American
Percent Hispanic
Kannapolis City Schools 75.8 28.3 23.8
Cabarrus County Schools 43.4 18.7 13.5
The Community Demographically As of 2014 it is estimated that Cabarrus County is home to 192,103 residents.6 The racial/ethnic composition
is 78.5% White, 16.2% Black/African American, and 9.7% Hispanic/Latino. It is worth noting that the proportion
of inhabitants in every minority sub-category increased from 2000 to 2010, highlighting an increase in racial
and ethnic diversity. Based on the 2013 estimate provided by the U.S. Census Bureau, there are slightly more
females (51.4%) than males. The age demographics in 2013 highlight that the largest segment of the population
is between the ages of 35-44 (15.3 %). Based on 2010 census data, there are slightly more females (51.2%) than
males and the majority of the population falls in the 5 – 17 (20.1%) and 18 – 64 (61.3%) age brackets. Children
under 5 years account for less than one tenth (7.3%) of the total population while seniors (65 years and over)
make up 11.3% of the population.
In 2013, 3,497 grandparents were living with their grandchildren. Of those, 45% of them were responsible for
their grandchildren. This is higher than the
national average. Nationally, 37% of
grandparents living with their grandchildren are
responsible for them. Nationally, 21.2% of
grandparents living with their grandchildren
have been responsible for their grandchildren
for 3 or more years, compared to 39.1% in
Cabarrus County.
In Cabarrus County, 26.1% of people are high
school graduates or equivalent, while 19.3%
4 Cabarrus County Schools Fact Sheet. Available at:
http://www.cabarrus.k12.nc.us/cms/lib09/NC01910456/Centricity/Domain/245/CCS_Fact_Sheet.pdf. Accessed April 21,
2015. 5 Kannapolis City Schools Fast Facts. Available at:
https://drive.google.com/file/d/0B6IS8mj9YgtuanlNckNoLXZuS28/view. Accessed April 21, 2015. 6 American Fact Finder. United States Census Bureau. July 1, 2013. Available at:
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2013_PEPANNRES&prodType=t
able. Accessed February 19, 2015.
11
obtained a Bachelor’s degree.7 Additionally, according to a 2010 estimate, it was reported that the median
household income for the zip codes in Cabarrus County.
The Community Geographically Located in south central North Carolina, Cabarrus County spans an area of 364.39 square miles and is bordered by Stanly, Union, Mecklenburg, Iredell, and Rowan Counties. Cabarrus is largely urban but includes a significant number of rural pockets across the county. The eastern half of the county contains the westernmost foothills of the Uwharrie Mountains and altitude ranges from approximately 500–800 feet above sea level. The longest waterway within Cabarrus is Rocky River, which rises in Iredell County and empties into the Pee Dee River in Stanly County.
Figure 1: Cabarrus County Map
7 Amercian Fact Finder. Unites States Census Bureau. 2013. Available at:
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_DP02&prodType=table.
Accessed March 6, 2015.
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II. Community Needs: Data Collection Methods
Quantitative Data
Quantitative data collection included a review of all existing available data sources. This included data from NC
DETECT on ED visits, the North Carolina Behavioral Risk Factor Surveillance System, the North Carolina
Department of Health and Human Services, and the 2009 Cabarrus County Youth Risk Behavior Survey.
Coalition members collaborated with leadership at local agencies to get additional data that was not publicly
available. This included data from EMS regarding the number of times Naloxone has been used in the past year;
data regarding the number of providers in Cabarrus registered with the Controlled Substances Reporting
System; law enforcement data regarding the number of drug related larcenies, and the number of drug-related
arrests at schools. Data regarding the number of deaths related to various drugs in Cabarrus County was
provided by Community Care of Southern Piedmont. Project Lazarus (a North Carolina nonprofit) provided data
on the hospitalization and prescription rates in Cabarrus and surrounding counties.
Recognizing a lack of recent information
regarding youth substance use, the Coalition
conducted a county-wide survey that was
administered to approximately 5% of all
middle and high school students in February
2014. The 2014 Cabarrus Youth Risk Behavior
Survey (2014 CYRBS) included questions
from the 2009 Youth Risk Behavior Survey (2009 CYRBS) regarding student behaviors and use of various
substances in their lifetime and the past 30 days. This has allowed the Coalition to begin tracking trend data.
Additional questions were developed to gather student perspectives regarding why their peers use drugs.
A Medication Safety Survey was distributed at two community events: A safety fair and a prescription drug
take-back event. The brief survey asked about what medications were kept in the home, how families store
their medications, and how families dispose of their medications. 16 surveys were collected at these events.
Finally, the Coalition developed two additional surveys that would find specific data for our local conditions
related to substance use. One survey was designed to target adolescents in middle and high school and one
survey was designed to gauge parent perspectives, attitudes, and behaviors. These survey tools can be found
in Attachment A. Surveys were put into Survey Monkey and were promoted by local agencies and through
social networks.
Qualitative Data
The Coalition conducted 28 individual interviews with stakeholders to gather detailed qualitative data.
Interviewees included representatives from stakeholder agencies, such as Cabarrus Health Alliance, Cabarrus
County Department of Human Services, Cabarrus County Sheriff’s Office, a school principal, teens, and the faith
community. In addition, we conducted group discussions with nearly 90 stakeholders at a large community
forum in March 2014. The community forum included representatives from schools, the faith community, city
Recognizing a lack of recent information regarding youth substance use, the Coalition conducted a county-wide survey that was administered to approximately 5% of all middle and high school students in February 2014.
13
and county government, healthcare agencies, substance use agencies, and other stakeholders. Participants
were asked about what substance use issues they perceive in their community, what resources are available,
and where they would like to see the Substance Use Coalition focus its efforts. Finally, three listening sessions
have been conducted. In April 2014, a focus group with Cabarrus Health Alliance’s Teen Task Force was held.
Approximately 20 students participated and discussed questions regarding what substance use issues were
common among their peers, why their peers use drugs, and what can be done to enhance prevention efforts.
A second focus group was conducted with the Cabarrus Wellness Coalition, which includes approximately 15
individuals representing Cabarrus Health Alliance, Concord Kannapolis Area Transit, Cabarrus Rowan
Community Health Centers, the Community Free Clinic, Community Care of Southern Piedmont and others.
Finally, preliminary youth data was presented to the Interagency Student Services Management Team (ISSMT),
which includes several school counselors and student services staff in addition to representatives from local
agencies that serve youth and families. Approximately 25 attendees participated in a discussion regarding what
substance use issues they perceive, what resources are available, and what strategies are needed.
Environmental Scans
To further assess access and availability of substances in Cabarrus County, an environmental scan of the Town
of Harrisburg was conducted on September 8, 2014. We examined Town Center, Harrisburg Park, and several
neighborhoods. The scan revealed that there are numerous neighborhoods existing and under construction.
The value of most homes in these neighborhoods is over $300,000. Although we observed numerous
residences, the town did not seem to have many visible activities or recreation centers. We observed a few
parks, several restaurants, and a couple of small shopping centers. It was also noted that Giant Genie Pharmacy,
CVS, and Rite Aid were all in very close proximity to one another in Town Center.
A second environmental scan was conducted of the Logan Neighborhood in Concord on September 25, 2014.
Pastor Donald Anthony, who leads Grace Lutheran Church in the Logan community provided a driving tour.
Logan is a low-income area located just south of Downtown Concord. In this neighborhood, homes are small
and many are dilapidated. There are also public housing units. The area suffers from absentee landlords who
collect rent and do not maintain their properties. Yet despite the area’s economic challenges, there are also
many community strengths and assets. An active neighborhood association worked with the City of Concord
to revitalize a park that was once a hot spot for drug deals. Now the park has a 1.4 mile walking trail (requested
by residents), a building and shelter for community events, and a playground. In addition, the Logan Multi-
Purpose Center offers a variety of recreational opportunities that are either free or low cost. Many adolescents
come here after school to use the game room, which features foosball, air hockey, and table tennis. Finally,
Habitat for Humanity has recently built several new houses in the neighborhood.
An additional environmental scan was conducted on October 12, 2014 of downtown Kannapolis and Concord.
The scan revealed that Kannapolis features many old mill houses. The downtown area appeared to be going
through a community revitalization with the North Carolina Research Campus taking up real estate where
Cannon Mill was once located (see Community History for more details). Although there are many universities
involved in research campus activities, the downtown area is not lively. Many buildings around the area remain
vacant. There is a clear social and economic divide between Kannapolis and downtown Concord. Downtown
Concord has large old homes and a busier downtown area. In Concord, we observed that the lawns were
manicured and homes were well maintained. The streets were populated with people walking and socializing.
However, there are several struggling neighborhoods within Concord as well, particularly the Logan and McGill
neighborhoods.
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Environmental Scan Pictures
Harrisburg Town Hall/YMCA
Concord Downtown Historic Concord
Kannapolis Downtown Kannapolis Mill Houses
15
Results from Data Collection
Consequences General Substance Use SCHOOL BEHAVIORAL PROBLEMS: During the 2013-2014 school year, Kannapolis City Schools district had 12
disciplinary referrals for alcohol and/or drug issues (7 at Kannapolis Middle School and 5 at A.L. Brown High
School). All of these referrals resulted in out of school suspensions. In addition, one-on-ones and the Teen Task
Force group discussion revealed that when students begin to use drugs, there is a noticeable decline in their
athletic and academic performance.
TRAFFIC CRASHES: Across the state, drugged driving education and enforcement has been a priority. The
National Highway Traffic Safety Administration (NHTSA) released a study in 2009 that revealed that 18% of
fatally injured drivers tested positive for at least one illicit, prescription, or over-the-counter drug (an increase
from 13 percent in 2005)8. It is important to note that it is difficult to measure the exact contribution of drug
intoxication to driving accidents, because blood tests for drugs other than alcohol are inconsistently performed,
and many drivers who cause accidents are found to have both drugs and alcohol in their system, making it hard
to determine which substance had the greater effect.6
OTHER CONSEQUENCES: Consequences that were reported by interviewees included: declining school
performance among adolescents, an attitude of ‘not caring’ about school or other responsibilities, losing jobs,
and losing children (reported by DHS staff). The Teen Task Force group discussion revealed that they feel their
peers’ personalities change when they use drugs.
Alcohol TRAFFIC CRASHES: In a report generated by NHTSA, Cabarrus County had 28 alcohol-related crashes between
the years of 2005-2009. NHTSA reports that alcohol-impaired-driving fatalities increased by 4.6 percent in 2012
in North Carolina, accounting for 31 percent of overall traffic fatalities6.
GRADES: Many interviewees
indicated that substance use had
negative consequences for school
performance. This belief was
confirmed by the 2014 CYRBS. In the
graph below, we see where better
grades are associated with lower rates
of alcohol use, particularly among
middle school students. It is
interesting to note that among high
school students, even students with
high grades have a fairly high rate of
8 NHTSA Reports Drug Use Among Fatally Injured Drivers Increased Over the Last Five Years. National Highway
Traffic Safety Administration. November 2010. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811415.pdf. Accessed
October 19, 2014.
8%15%
26%
36% 33%
5%
37%
46%
56%
44%50%
39%
0%
10%
20%
30%
40%
50%
60%
Mostly A's Mostly B's Mostly C's Mostly D's Mostly F's Not Sure
Chart 1: The distribution of grades in Middle School and High School by ever use of alcohol
Middle School High School
16
lifetime alcohol use, with (37%) of A students reporting having used alcohol. A similar correlation was observed
between alcohol use and unexcused absences. Students who reported a higher number of unexcused absences
were more likely to report having used alcohol.
Marijuana GRADES: For marijuana, we see that high school students with A’s and B’s are less likely to report having used
marijuana. Although marijuana use is much lower among middle school students, there is still a correlation
between grades and marijuana use.
ADOLESCENT ARRESTS: The Kannapolis City Police Department reported 34 school arrests for marijuana between 2010 and 2013. The number of arrests has declined from 11 in 2010 to 6 in 2013. This may be due to the fact that school staff often try to handle substance use issues without police involvement by working with the families and getting the student treatment if needed.
Prescription Drugs
OVERDOSE: Between 1999 and 2010, Cabarrus County witnessed an 850% increase in the number of
unintentional medication or drug-related poisoning deaths from 2 to 19 (Community Care of North Carolina).
The vast majority of these deaths were
caused by prescription opioids. In 2010,
there were 19 unintentional medication or
drug-related poisoning deaths, 15 of which
were caused by prescription opioids. While
mortality has declined since it peaked in 2005, the number of deaths in 2011 is still far higher than it was in the
early 2000s. Compared to the state overall, Cabarrus County had a significantly higher rate of unintentional
medication and drug-related poisoning emergency department visits in 2012 (125.7 per 100,000 vs. 87.3 per
100,000) (Community Care of North Carolina). Data from EMS also demonstrates the extent of the prescription
and illicit drug problems in Cabarrus County. The EMS Assistant Director in Cabarrus reports that they
2%6%
8% 7%
29%
5%
21%
26%
41%
33%
50%
18%
0%
10%
20%
30%
40%
50%
60%
Mostly A's Mostly B's Mostly C's Mostly D's Mostly F's Not Sure
Chart 2: The distribution of grades in Middle School and High School by ever use of Marijuana
Middle School High School
Between 1999 and 2010, Cabarrus County witnessed an 850% increase in the number of unintentional medication or drug-related poisoning deaths.
17
responded to 369 calls in 2013 related to prescription and illicit drugs. EMTs used Naloxone in 231 cases during
that period in response to opioid overdoses.
CRIME INCREASE: 38% of one-on-one interviews indicated that a major consequence of prescription drug
abuse is an increase in crime. The Cabarrus County Sheriff’s Office reported 45 cases of larceny related to
prescription drugs in 2013, a significant increase from 33 incidents in 2012.
Problem Behaviors General Substance Use Chart 3 shows reported lifetime use of substances among high school students in Cabarrus County. Data comes
from the 2009 and 2014 Youth Risk Behavior Surveys.
These findings were confirmed by interviews, with the majority of respondents stating that alcohol, marijuana,
and prescription drugs were the most prevalent substances presenting issues in the community. Among teens
and respondents who interact with adolescents, ecstasy (molly) was also mentioned several times.
Alcohol ADOLESCENT USE: The 2014 Youth Substance Use Survey revealed that 40% of high school students had ever consumed alcohol, while only 14% of middle school students reported that they had ever used alcohol. Among students who reported ever using alcohol, 48% of high school students had used within the past 30 days and 29% of middle school students had used within the past 30 days. The 2014 CYRBS
63%
34% 36%
20%
40%
16%
26%
11%
0%
10%
20%
30%
40%
50%
60%
70%
Alcohol Cigarettes Marijuana Prescription Drugs (nodoctor's order)
Chart 3: Ever Use of Substances Among High School Students
2009 2014
The 2014 CYRBS found that 57% of middle school students who had drank alcohol in the past 30 days
took it from a store or family member.
18
found that 57% of middle school students who had drank alcohol in the past 30 days took it from a store or family member. Among high school students, 27% of those who had consumed alcohol in the past 30 days reported giving someone else money to buy it from them while 49% said that they got it some other way. School social workers and counselors who were asked to assess substance use in their schools most frequently reported alcohol as being the most common substance use issue (88% of respondents). 43% of one-on-one interviewees reported that they perceived alcohol as a substance that widely affects our community. BINGE DRINKING: The 2014 CYRBS assessed lifetime
use of alcohol, past 30 day use of alcohol, alcohol use
on school property, and binge drinking. Among
students who reported consuming alcohol in the past
30 days, 12% of high school students and 9% of middle
school students consumed alcohol on school property.
Furthermore, 40% of high school students and 17% of
middle school students who had consumed alcohol in
the past 30 days reported binge drinking. USA Today
released an article in 2013 highlighting a recent study
that found high school seniors who drank 15 or more
drinks at a time in the two weeks preceding the survey
were significantly more likely to use other drugs than those who did not binge drink.9
Marijuana
ADOLESCENT USE: The 2014 CYRBS revealed that 26% of high school students and 5% of middle school students had used marijuana. Of the students who reported ever using, 49% of high school students and 46% of middle school students had used in the past 30 days. Students who reported marijuana use were also asked about
frequency of marijuana use. 26% of high school students who had ever used marijuana reported using marijuana 100 or more times in their lifetime. Among middle school students who had ever used marijuana, 72% reported using fewer than 10 times.
9 Hellmich, Nancy. 1 in 10 high school students are extreme binge drinking. USA Today. September 16, 2013. Available
at: http://www.usatoday.com/story/news/nation/2013/09/16/extreme-binge-drinking-seniors/2809739/. Accessed March
26, 2015.
The 2014 CYRBS revealed that 26% of high school students and 5% of middle school students had used
marijuana.
19
The 2014 CYRBS also revealed that among high school students who had smoked 20 times or more 80% had
first used marijuana before age 14. This highlights the importance of targeting middle school aged students for
prevention even though substance use is less common at that age.
Prescription Medication ADOLESCENT USE: Chart 3, on page 17, shows that 11% of high school students reported having ever used
prescription drugs without a doctor’s order. This may underestimate the rate of prescription drug misuse as it
likely does not encompass when students take more medication than prescribed or continue taking a
prescribed medication after it is needed or expired. Furthermore, of the students who reported ever taking a
prescription drug without a doctor’s order, the students reported most frequently using OxyContin,
Hydrocodone, Percocet or Vicodin (See table below). When the students who reported using the painkillers
were asked about the
frequency at which they
use the substance, 55% of
high school students and
31% of middle school
students reported using
the substance 1 or 2 times.
PRESCRIBING RATE: The
state of North Carolina
ranks 13th in the country for
prescribing of opioid pain
relievers with a prescribing
10%
31%
11%
35%
52%
32%
0
10
20
30
40
50
60
Adderall or Ritalin Oxycontin, Hydrocodone,Percocet, or Vicodin
Valium or Xanax
Chart 5: Prescription drug use among students who reported ever use without a doctor's prescription
Middle School High School
29%
43%
16%
6%4%
2%
26%
21%
12%
8% 8%
26%
0
5
10
15
20
25
30
35
40
45
50
1 or 2 times 3 to 9 times 10 to 19 times 20 to 39 times 40 to 99 times 100 or more times
Chart 4: Frequency of marijuana use among students who ever used marijuana
Middle School High School
20
rate of 96.6 per 100 persons10. In 2011, the controlled substance prescribing rate in Cabarrus County was
191,042 per 100,000 population (Project Lazarus data). The 2014 CYRBS revealed that 11% of high school
students had used a prescription drug without a doctor’s order.
Root Causes and Local Conditions General Substance Use AVAILABILITY: As one of the largest counties in the state, it is likely that alcohol and drugs are particularly
accessible, encouraging use in the county. Charlotte is easily accessible from most parts of Cabarrus County via
Highway 85 and Highway 49. The 2014 CYRBS found that 54% of middle school students and 71% of high school
students agree that kids use drugs because they are available. Disturbingly, the Coalition has learned that drugs
are available on school campuses, with nearly 30% of high school students reporting that they have been
offered, sold, or given an illegal drug on school property in the past 12 months (CYRBS, 2009).
COMMUNITY NORMS: The 2014 CYRBS revealed social and cultural reasons why students use drugs. The most
common responses were that 82.6% of kids use drugs because they are curious, 82.3% use drugs to look cool,
83% use because being high feels good, and 81.5% use because kids think that drugs help them when they are
having a hard time. In addition, 55% of students use drugs because they do not think they are harmful. This
was confirmed by individual interviews, where many interviewees said that adolescents get alcohol, marijuana,
and prescription drugs from their parents or other family members such as older siblings and cousins.
FAVORABLE YOUTH ATTITUDES: Charts 6, 7, and 8 show of all students who “Agree” or “Strongly Agree” with
perceptions of drug use. Data comes from the 2014 CYRBS. 79% of middle school students and 90% of high
school students believe kids use drugs because they are curious. More than half of students agree that their
peers do not think drugs are harmful. Less than
half of students perceive that their peers use
drugs to enhance athletic performance. Many
students use substances to have fun or to deal
with their problems. Students have pro-favorable
perceptions toward drug use at parties with more
than 80% of high school males and females
reporting that kids think that parties are more fun
with drugs. Furthermore, 92% of high school
students agreed that kids think that being high
feels good. 55% of middle school and 64% of high
school students use drugs because they do not
think that they are harmful (CYRBS, 2014).
10 Wheaton AG, Shults RA, Chapman DP, Ford ES, Croft JB. MMWR. Morbidity and mortality weekly report. Centers
for Disease Control and Prevention. 2014; Vol. 63, no. 26. Available at: http://stacks.cdc.gov/view/cdc/29250. Accessed
February 14, 2015.
21
41%
79%
55% 59%54%
38%
90%
64% 67% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Kids use drugs toimprove their
athletic performance
Kids use drugsbecause they are
curious
Kids use drugsbecause they don't
think they areharmful
Kids use drugs torebel
Kids use drugsbecause they are
available
Chart 6: The percentage of all students who "Agree" or "Strongly Agree" with perceptions
Middle School High School
69% 67%
54%
78%87% 84%
70%
92%
0
10
20
30
40
50
60
70
80
90
100
Kids believe that drug arefun
Kids think that parties aremore fun with drugs
Kids believe that drug usersfeel adventurous
Kids think that being highfeels good
Chart 7: The percentage of students who "Agree" or "Strongly Agree" with perceptions
Middle School High School
22
Alcohol AVAILABILITY: 71.6% of teens reported that alcohol is fairly easy or very easy to get (2015 Teen Medication Survey). The 2014 CYRBS found that 57% of middle school students who had consumed alcohol in the past 30 days reported that they took alcohol from a family member, friend, or from a store. High school students were more likely to report giving money to someone to purchase alcohol for them (27%). One-on-one interviews with adolescents confirmed that many teenagers have older siblings, cousins, or significant others who are willing to purchase alcohol for them (local condition). FAVORABLE YOUTH ATTITUDES: 24.7% of teens believe that there is no risk to slight risk to have 5 or more alcoholic drinks once or twice a week. 15.2% of adults who participated in the 2015 AMS reported that there is no risk to slight risk to having 5 or more alcoholic drinks once or twice a week. FAVORABLE PARENTAL ATTITUDES: Students were least likely to report that their parents disapprove of them using alcohol. The 2014 CYRBS found that 78% of middle school students and only 70% of high school students reported that their parents would disapprove of them having 1-2 drinks of alcohol occasionally. 89% of middle school students and 86% of high school students reported that their parents would disapprove of them having 1-2 drinks of alcohol regularly. Binge drinking was still widely disapproved of, with 94% of middle school students and 92% of high school students saying their parents would disapprove of them having 5 or more drinks of alcohol within a couple of hours.
Marijuana
AVAILABILITY: 71.9% of teens reported that marijuana is fairly easy or very easy to get (2015 Teen Medication Survey). FAVORABLE YOUTH ATTITUDES: The 2015 Teen Medication Survey found that 50% of teens believe that there is no risk to slight risk to smoking marijuana twice a week. Furthermore, adolescents widely believe that marijuana is not harmful and that it aids relaxation and stress reduction (local condition). 65% of middle school students and 90% of high school students agreed that kids believe that marijuana helps you relax. 50% of teens think there is no risk or slight risk to smoking marijuana once or twice a week
67%74% 77% 74%
79%88% 87% 85%
0
10
20
30
40
50
60
70
80
90
100
Kids think that drugs helpthem deal with problems
Kids believe that drugs helpyou forget your troubles
Kids think that drugs helpthem when they're having a
hard time
Kids use drugs to deal withthe pressures and stress of
school
Chart 8: The percentage of all students who "Agree" or "Strongly Agree" with perceptions
Middle School High School
23
FAVORABLE PARENTAL ATTITUDES: The 2015 Adult Medication Survey found that 28.6% of adults reported that there is no risk to slight risk to smoking marijuana once or twice a week. Among high school students, only 84% reported that their parents would disapprove of them smoking marijuana occasionally. In comparison, 92% of high school students say their parents would disapprove of them binge drinking and 95% say their parents would disapprove of them using cocaine (2014 CYRBS) COMMUNITY NORMS: With the legalization of marijuana in several states, the perception that marijuana is harmful is fading (local condition). Marijuana is the most common illicit drug used in the United States, even though it is considered a Schedule 1 substance with a high risk for abuse.11 The diminished perception of harm for marijuana was confirmed by the 2014 CYRBS. Among surveyed students, 52% of middle school students and 80% of high school students agreed that kids think that marijuana is natural and therefore not harmful.
Prescription Drugs:
AVAILABILITY: The 2014 CYRBS revealed that 71% of high school and 54% of middle school students use drugs because they are available. 63.2% of teens reported that prescription medications are fairly easy or very easy to get (TMS, 2015). 66.7% (8 out of 12 tables) of participants believe that easy access to prescription medications is one of the top what that substance use affects Cabarrus County. Medications are available to youth in the home due to families not storing and disposing of medications properly (local condition). 73.3% of adults and 42.3% of teens think teens get prescription medications that are misused from someone they live with (AMS, TMS, 2015). Additionally, one-on-one interviews and a community-wide forum revealed that kids are getting prescription medications from their parent’s medicine cabinets. 42% of one-on-one interviews reported that kids get prescription medications from home. 28.2% of people had expired or unused medications currently in their home and 44% reported that they store their prescriptions in an unlocked cabinet or drawer (2015 Adult Medication Survey). The 2015 AMS reported that only 13.6% of teens says that their household stores prescription medication in a locked cabinet, drawer, or container and 10.5% of adults reported that their household stores prescription medication in a locked cabinet, drawer, or container. The Medication Safety Survey found that 25% of respondents report that they had painkillers such as OxyContin, Percocet, or Hydrocodone in their home. Zero respondents from the 2014 Medication Safety Survey said they disposed of unused or expired medications using prescription drop boxes, take back events, or by combining them with an undesirable substance such as coffee grounds and throwing away. Only 18.9% of adults reported disposing of unused or expired prescriptions correctly either by designated drop box/medication take-back event or mixing them with coffee grounds and then throw them away (AMS, 2015). Teens are commonly prescribed medication for sports injuries (local condition). 30.2% of teens report being
prescribed medication by a doctor for a sports injury and 20.9% of parents report that their child has been
prescribed medication by a doctor for a sports injury (TMS, AMS, 2015). Of the students that reported that
they had been prescribed medication by a doctor, 15.3% of them said that they have used prescribed
11 Marijuana. National Institute of Drug Abuse. April 2, 2015. Available at:
http://www.drugabuse.gov/publications/drugfacts/marijuana. Accessed January 16, 2015.
42% of one-on-one interviews reported that kids get prescription medications from home.
24
medications after the prescribed time frame for other injuries, pain, or for nonmedical purposes (TMS, 2015).
29% of one-on-ones said that people get prescription medications from doctors and the TMS 2015 revealed
that in the teen’s opinion, teens get prescription medications that are misused because a doctor prescribed it
to them. Additionally, school personnel reports that it is very obvious when athletes start using substances
because their performance decreases and indicated that athletes are getting prescribed for injuries and are
misusing and sharing (one-on-ones).
An additional factor that may be indirectly increasing prescription medication availability in Cabarrus County is
that only 32.8% of primary care physicians and 51% of pharmacists are registered for CSRS (local condition).
In 2011, the controlled substance prescribing rate was 191,042 per 100,000.
FAVORABLE YOUTH ATTITUDES: 45.7% of teens believe there is a slight risk to moderate risk to try someone else’s prescription medication once or twice. 32.6% of people believe that there is no risk or slight risk with trying someone else’s prescription once or twice. 50.5% of teens agree or strongly agree that teens misuse prescription medications because they do not think that they are harmful (TMS, 2015). Furthermore, 58% of community stakeholders say that it is prevalent and socially acceptable for teens to misuse prescription medications as a solution to dealing with life stresses and challenges (Community Wide Forum).
People share prescription medications to help friends and family treat a similar health problem (local condition). 58.8% of adults and 62.2% of teens report that people share medications to help a friend or family member treat a similar health problem (AMS, TMS 2015). 25% of teens agree or strongly agree that it is okay to share prescription medications with someone if they have been prescribed a similar medication in the past (TMS, 2015).
33% 34%
82%
51%44%
49%
0
10
20
30
40
50
60
70
80
90
Cabarrus Rowan Stanly
Chart 9: Practitioners and Pharmacists Registered on the Controlled Substances Reporting System
Practitioners Pharmacists
25
Teens use prescription medication after school and on weekend to deal with stress/problems (local
condition). 62% of teens agree or strongly agree that teens misuse prescription medications to help them deal
with problems (TMS, 2015). In our community, teens shared that they have 'kickbacks' afterschool where they
have food, music, and share drugs as a way to unwind (one-on-ones). The 2015 TMS revealed that 29.1% of
teens misuse prescription medications to help them deal with problems and a focus group with our Teen Task
Force agreed that stress is a problem. Unfortunately, people believe that prescription medications are safe
because they are prescribed by a doctor
(Community Wide Forum). Likewise, 58% (7
out of 12 tables) say that it is prevalent and
socially acceptable for teens to misuse
prescription medications as a solution to
dealing with life stresses and challenges
(Community Wide Forum).
Prioritization Process
Cabarrus Health Alliance conducted a needs assessment in 2012 that highlighted mental health as one of the
leading problems in our community with substance use being a key factor. Based on data from primary and
secondary sources, the Healthy Cabarrus Substance Use Coalition has identified prescription drug use among
teens as a leading issue in our community based on quantitative and qualitative data that has been collected
over the past year. Although alcohol and marijuana are more frequently used among adolescents, the Coalition
will pursue prescription drug misuse due to the more severe consequences associated with prescription drugs.
Through the use of the logic model, the coalition has identified two root causes: 1) availability of prescription
drugs 2) favorable youth attitudes toward prescription drug use and abuse. These root causes are supported
by data that the coalition has collected. The coalition identified 2 data driven local conditions that highlight key
issues in our community: 1) medications are available to youth in the home due to families not storing or
disposing of medications properly 2) teens use prescription medications after school and on the weekend to
deal with stress and problems.
62% of teens agree or strongly agree that teens misuse prescription medications to help them deal
with problems (TMS, 2015).
26
III. Community Resources
Describe the Resource Data Collection Methods Used:
A. Quantitative: The Coalition reviewed the Cabarrus County Health Resource Inventory, the 2012 Cabarrus
County Community Needs Assessment, and the preliminary Substance Use Action Plan that was created in
conjunction with the 2012 Community Needs Assessment.
B. Qualitative: At the community forum that was held in March 2014, participants were asked to list existing
resources that they were aware of. Coalition members have also discussed the resources that their
agencies can provide.
C. Environmental Scans: A total of 3 environmental scans were completed by members. Noted were health
care facilities, human services agencies, pharmacies, and socioeconomic differences between communities
in the County.
People
The following table lists the current members of the Substance Use Coalition who will contribute their time
and expertise to the Coalition’s efforts:
MEMBER NAME MEMBER ORGANIZATION
Lydia Adams Cabarrus Rowan Community Health Centers
Sabrina Adair Center for Prevention Services
John Basilice Cabarrus County Schools
Dyana Bostian Habitat for Humanity
Jessye Brick Cabarrus Health Alliance
Cheryl Brooks Cabarrus County Schools
Jessica Castrodale CMC-NE
Jennifer Collins Department of Human Services
James Cooke Community Care of Southern Piedmont
Paige Gesing CMC-NE Trauma Center
Erin Greene Community Care of Southern Piedmont
Kelly Hinebaugh Cabarrus Department of Human Services
Ed Hosack Cooperative Christian Ministry
Carol Hovey CMC-NE Faith Community Health Ministry
Monica Johnson Cardinal Innovations
Kristin Klinglesmith Healthy Cabarrus: Substance Use Coordinator
Nancy Litton Center for Prevention Services
LaKeisha McCormick Center for Prevention Services
Joe Moose Moose Pharmacy
Johnny Phillips Cardinal Innovations Healthcare Solutions
Amanda Prevette Department of Human Services
Mark Robinson Cabarrus Family Medicine
Delton Russell Cardinal Innovations Healthcare Solutions
Barbara Shepard Healthy Cabarrus-Executive Director
Betty Stocks Concord Police Department
Anissa Thaddeus Teen, Concord High School
Lauren Thomas Healthy Cabarrus, Executive Director
27
Angela Ward Kannapolis City Schools
Facilities, equipment and supplies: Cabarrus Health Alliance has a large community room that is available for Coalition meetings and other community events. It is equipped with projectors and speakers. Cabarrus Health Alliance also has an on-site IT department that is available to assist as necessary between the hours of 8am – 5pm. Community Care of Southern Piedmont has a large meeting room that is available for meetings and events. Organizations and prevention programs: There are several existing organizations and programs that address substance use. However these primarily focus on treatment rather than prevention. Existing organizations and prevention programs include:
TASC: Treatment Accountability for Safer Communities—The primary function of TASC is to identify individuals being processed through the criminal justice system, who are suffering from substance use or mental health problems, and to provide an alternative to incarceration. TASC monitors the treatment of all clients and services are in lieu of, or in addition to, court/probation/parole judgments. Through its services, TASC offers treatment and rehabilitation instead of a return to drugs and/or alcohol and ultimate re-entry into the criminal justice system.
The Center for Prevention Services—This agency works with parents, educators, and community leaders to implement research-based prevention programs that meet the specific need of the community. This organization operates primarily in Charlotte but does provide education to The Glen Center (the alternative school in Cabarrus County).
The Piedmont Area Substance use Providers Association (PASAPA)—PASAPA provides substance use training series each year that includes topics such asethical boundaries, advanced crisis planning, the addicted brain, and bringing prevention to the community.
12-step Recovery Programs—Alcoholics Anonymous and Narcotics Anonymous meetings are available throughout the county. Additional information is available at http://www.45.aa-carolina.org/local-aa-meetings.html.
Daymark and RHA Health Services—These agencies offer the The Seven Challenges® Program, which is designed specifically for adolescents with drug problems, to motivate a decision and commitment to change - and to support success in implementing the desired changes. The Program simultaneously helps young people address their drug problems as well as their co-occurring life skill deficits, situational problems, and psychological problems. The Seven Challenges is listed as an evidence-based program in the SAMHSA National Registry of Evidence-Based Programs and Practices.
PASS Program—Cabarrus County Schools (CCS) offers this alternative to suspension program which consists of an 8-hour course for first time offenders and their parents. The PASS program is currently working on implementing the GAIN short screener to measure effectiveness. The program does not apply to students who are found to be distributing drugs.
28
Re-Entry Plan—Kannapolis City Schools (KCS) has a policy where suspension is decreased if a student goes through an assessment and follows recommendations from Daymark or a private clinician. Principals have the authority to decide whether or not a student is eligible and services must be obtained at the student’s expense.
DARE—CCS and KCS provide DARE to all 5th grade students. DARE is a police-officer-led series of classroom lessons that teaches children how to resist peer pressure and live productive drug and violence-free lives.
GREAT—KCS provides this evidence-based gang and violence prevention program to all middle school students through their social studies classes. The program is provided by the School Resource Officer and is intended as an immunization against delinquency, youth violence, and gang membership for children in the years immediately before the prime ages for introduction into gangs and delinquent behavior.
General course of study health class—CCS and KCS provide basic substance use education to 4th through 9th grade students via health classes as required by the North Carolina Department of Public Instruction. Class material is science-based but no evidence-based program is used.
Operation Medicine Drop—Safe Kids Cabarrus offers the public a free and convenient option for disposing of their prescription and over-the-counter medications to protect their families and the environment. Special take back events are held occasionally throughout the year. A permanent drop box is located at the Kannapolis Police Department but awareness of this resource is extremely low.
Project Lazarus—A public health model based on the premises that drug overdose deaths are preventable and communities are responsible for the health of its residents. The model components include: community activation and coalition building, monitoring and epidemiologic surveillance, prevention of overdoses through medical education and other means, use of rescue medication to reverse overdoses by community members, and evaluation of project components. Funds have been provided for a 2-year, statewide expansion of a Wilkes County-based model that addresses chronic pain issues and prescription drug overdose. The Kate B. Reynolds Charitable Trust and The NC Office of Rural Health and Community Care provided $1.3 million each to help Community Care of NC (CCNC) implement a community- based approach modeled after Wilkes County Project Lazarus.
Systems and Infrastructure: As the public health authority for Cabarrus County, CHA developed Healthy Cabarrus in 1999 along with key stakeholders. Healthy Cabarrus is a strategic initiative housed by CHA with the mission of uniting and mobilizing community partners to identify and address health needs. The organizational structure of Healthy Cabarrus includes an Executive Committee, Advisory Board, and sub-Coalitions that are developed as needed to address specific priority issues. The Executive Committee is a six member board with representation from mental health, city government, non-profit, education, public health, and traditional healthcare. The Advisory Board has a broad-base of community representation with over 35 active members on the board. Healthy Cabarrus is committed to selecting and implementing evidence-based approaches that address individual, community, and environmental factors. Laws and policies: Healthy Cabarrus has dedicated attention to implementing smoke-free policies throughout the county. This includes a smoke-free policy in Cabarrus County Parks, at Cabarrus Health Alliance, and at some multi-unit housing complexes. In regards to other substances, the County does not have any policies
29
above and beyond state legislation. For example, liquor can only be sold in certified ABC stores. The Overdose Prevention Law in NC, also known as the 911 Good Samaritan and Naloxone Access Law, is another example of relevant statewide law. As of April 9, 2013, a person who seeks medical assistance for someone experiencing a drug overdose cannot be prosecuted for possession of small amounts of most drugs or for possession of drug paraphernalia if evidence for the charge was obtained as a result of that person seeking help. The victim is protected from these charges as well. In addition, law now allows doctors and other medical providers to prescribe naloxone, a non-addictive prescription medication that reverses opioid drug overdose, to people at risk of overdose and their family/or friends who can administer the drug in the event of an overdose. Providers prescribing and those administering the drug in the event of an overdose are immune from any civil or criminal chargers as long as they act in good faith.
Funding: The Healthy Cabarrus Substance Use Coalition received $27,700 from the North Carolina Coalition Initiative for FY 2015. This funding has enabled the hiring of a part-time Coordinator and participation in the CADCA Academy. The Coalition also is expecting to receive $8,500 for FY 2015 to begin implementation of Project Lazarus.
Describe any gaps in community resources: As previously described, the majority of substance use services in Cabarrus County focus on treatment rather than prevention. A gap that the Coalition has identified is the need to address maladaptive coping mechanisms among youth. This is perceived as the root of substance use issues in our community. There is a significant gap in regards to medicine drops. Medicine drops occur, but unfortunately the events are not always publicized adequately. There is a need to have a host agency responsible for the advertising and planning of community events in order to increase effectiveness. The county only has one prescription drop box which is located in the very northern part of the County and is poorly advertised so that very few are aware of its existence.
30
IV. Community History Cabarrus County earned wide acclaim in the late-eighteenth century when the first gold rush in the entire
nation occurred at Reed Gold Mine. Some of the largest nuggets of all southern mines came from the Reed
mine, and it remained the leading mine of the gold rush until California took over at the beginning of the 1850s.
Textiles became the main industry of Cabarrus County after the gold rush in the late 1800s and early 1900s.
Founded in 1888, Cannon Mills became
world renowned for Cannon brand sheets
and towels. At its height, Cannon Mills
(later known as Pillowtex) produced
300,000 towels each day and was the
world’s largest producer of textiles. The
City of Concord was also home to the
Coleman Manufacturing Company, the
first U.S. cotton mill that was owned and
operated by African Americans, from
1899 - 1904. By the end of the 1900s,
North Carolina textiles, along with those
in Cabarrus, began to struggle due to
exportation of labor to nations with cheaper labor. On July 30, 2003, the community suffered a major blow
when the Pillowtex Corporation, the county’s largest employer, announced its complete bankruptcy. As the
largest permanent layoff in the history of the Southeast, 7,650 individuals lost their jobs overnight. Meeting
the broad needs of these families and creating new jobs has been a leading priority in the county for the past
decade.
The legendary 1.5 mile superspeedway, now known as Charlotte Motor Speedway, was built in 1959. The
140,000-seat facility hosts two NASCAR events: the Coca-Cola 600 on Memorial Day weekend and the Sprint
All-Star Race in September. Numerous other activities take place at the Speedway, including three of the
country's largest car shows. In addition to the Charlotte Motor speedway, Cabarrus County is also the home of
The Dirt Track at Charlotte Motor Speedway. The track is a state-of-the-art facility that opened in 2000 and
seats 14,500 people. As of 2008, the zMAX Dragway has been the host of a variety of NHRA events.
In 1983, Philip Morris, the leading tobacco manufacturer and one of the top employers in the region opened
in Cabarrus County. Philip Morris was one of this city's largest taxpayers and employers. When the company
closed its doors in 2010, approximately 2,500 residents of Rowan and Cabarrus counties lost their jobs. A 2005
estimate said the company contributed around $268 million a year to Cabarrus County through employee
wages and taxes. The company offered to relocate many of the hourly and salaried employees to the plant in
Richmond, Virginia, which is now the largest Philip Morris plant in the world.
31
In 2005, construction of the North Carolina Research Campus (NCRC) began at the former location of the
Cannon Mills/Pillowtex factory. This public-private research center focuses on health, nutrition, and agriculture
and provides a collaborative space for corporations,
healthcare organizations, and numerous universities.
In 2013 the NCRC had created 151 new local jobs and
with the help of other campuses and academic
partners, the number of new employment
opportunities reached nearly 1,000, with
approximately half of the jobs being filled by local
residents.
Historical Origins of Related Issues
In 2013 five people were charged with trafficking more than two tons of marijuana to Concord using 1-85.12
Most recently, eight individuals in neighboring Rowan County were charged with running a prescription drug
ring. The plot was hatched by an elementary school teacher and her doctor husband, who wrote prescriptions
for hydrocodone that were filled by six others. Six of the eight individuals involved were school employees. The
group filled 200 illegal prescriptions and obtained roughly 25,000 pills over the course of 17 months.13
History of Organizing for Community Improvement
Collective responsibility for the wellbeing of all residents is at the heart of Cabarrus County’s culture. This
attitude and approach to community development dates back nearly a century. Charles A. Cannon, who served
as the President of Cannon Mills from 1921-1962, was highly committed to promoting the health and welfare
of his employees. After becoming President, he also provided affordable and equitable housing for employees.
In 1955, Cabarrus County became the first community in the country to vaccinate against polio when Mr.
Cannon purchased 100,000 doses of the vaccine for employees and children throughout the county. His
philanthropy has continued through The Cannon Foundation, which focuses on education, health, and human
services. Mr. Cannon’s generous spirit has been infused throughout the county, with community members,
local governmental agencies, businesses, nonprofits, schools, and other stakeholders recognizing the need to
work together to address the holistic needs of residents. These stakeholders put sustainability and partnership
development at the center of their programming efforts and formal collaboration exists through a number of
partnerships.
Formal collaboration among these entities was sparked in 1997, when Cabarrus Health Alliance (CHA) was
founded as the successor of the Cabarrus County Public Health Department. In direct response to this mission,
the new Board of Health’s first action was to develop a community partnership with the mission of uniting and
mobilizing stakeholders to identify and address health needs. This grassroots, independent entity became
Healthy Cabarrus. Since 1998, Healthy Cabarrus has convened representatives of government, business,
industry, schools, human service agencies, medical care providers, general public, and the faith community to
12 Reaves, Tim. FBI busts Mexican drug ring in Concord. Independent Tribune. May 29, 2013. Available at:
http://www.independenttribune.com/news/fbi-busts-mexican-drug-ring-in-concord/article_5de79e07-39b9-5535-aabc-
6a375c54ec5e.html. Accessed January 16, 2015. 13 Latos, A and Williford, T. Doctor, teacher wife accused in prescription drug ring. WSOC TV. July 9, 2014. Available at:
http://www.wsoctv.com/news/news/local/investigators-doctor-teacher-wife-accused-17-month/ngbdS/. Accessed
February 19, 2015.
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identify, assess, and prioritize community needs. Every four years, Healthy Cabarrus facilitates a
comprehensive Community Needs Assessment, which is then used to develop goals and action plans. Partners
throughout the county then implement action plan strategies, meeting regularly with each other and the
broader community to share progress, problem solve, and gather feedback. Examples of past priority issues
have included obesity prevention, access to care, access to dental care, and child maltreatment.
History of Organizing on Related Issues
Cabarrus County has a long history of collaboratively addressing pressing health concerns in the community
using promising and evidence-based strategies. Cabarrus Health Alliance has a wealth of experience in
promoting positive decision making and healthy families that will complement the efforts of the Substance Use
Coalition. Current programs include the Triple P Positive Parenting Program, an evidence-based program that
helps parents learn to positively manage their children’s behavior; and Smart Girls Know, a program that
infuses positive youth development and physical activity into an evidence-based teen pregnancy prevention
curriculum.
Healthy Cabarrus recognizes the value of environmental strategies and has extensive experience implementing
them in regards to other priority areas. For example, in 2010, Cabarrus County was selected to participate in
the Action Communities for Health, Innovation, and Environmental Change (ACHIEVE), funded by the National
Association of County and City Health Officials (NACCHO). This project brought together local leaders and
stakeholders to implement changes focused on physical activity, nutrition, and tobacco cessation. Although
the project was modestly funded, nearly forty new policy and environmental changes were adopted over the
course of an 18-month period. Examples include: nutrition labeling in our major hospital system, tobacco-free
policies at numerous worksites and City of Concord parks, and the inclusion of a city-wide Complete Streets
initiative in the City of Concord’s Development Ordinance.
The Healthy Cabarrus Substance Use Coalition was developed in 2013 in response to the identification of
substance use as a priority issue in the 2012 Community Needs Assessment. The Healthy Cabarrus Substance
use Coalition includes representatives from mental health, public health, healthcare, education, youth,
community, faith-based, law enforcement and others. Since the Substance use Coalition was initiated, efforts
have focused on building coalition capacity, collecting local data, and building community awareness. The
Coalition has begun partnering with Project Lazarus to examine how to implement the organization’s
comprehensive model in Cabarrus County While the Coalition will benefit from the experience of Healthy
Cabarrus leadership, participating in NCCI will provide members with substance use specific expertise. It will
allow members to be more engaged and committed, improving long-term sustainability.
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V. Problem / Goal Statements
Problem: Prescription drug misuse among high school students in Cabarrus County.
Cabarrus Health Alliance conducted a community needs assessment in 2012 that highlighted mental health as
a priority issue within our community. Substance use was identified as being a key factor. An important priority
of the coalition is to find the population most in need and that can be the best impacted. Based on data from
primary and secondary sources, Healthy Cabarrus Substance Use Coalition has identified prescription drug use
among teens as a leading issue in our community based on
quantitative and qualitative data that has been collected over
the past year. Although alcohol and marijuana are more
frequently used among adolescents, the coalition decided to
pursue prescription drug misuse due to the more severe
consequences associated with prescription drugs. The
majority of drug overdose deaths in Cabarrus County are a
result of prescription opioids. Furthermore, there have been
numerous arrests related to thefts and sales of prescription
drugs in recent years. The Coalition plans to address underage
drinking and marijuana in the future due to high levels of use
among adolescents.
Through the use of a logic model, the coalition has identified
two root causes, availability of prescription drugs and
favorable youth attitudes toward prescription drug use and
abuse. These root causes are supported by data that the
coalition has collected. The coalition identified 2 data driven
local conditions that highlight key issues in our community: 1) medications are available to youth because
unused and expired medications are left in the home due to families not disposing of medication properly
through at-home methods of local drop boxes and 2) medications are available for youth to use because
parents keep medication in unlocked cabinets or drawers. Two additional data driven local conditions were
also identified but will not be the focus of our interventions at this time: 1) teens are commonly prescribed
medications for sports injuries 2) people share prescription drugs to help friends and family members treat
similar health problems.
Goal Statement
Long Term Objective:
To reduce the percent of all high school students (9th-12th) that have ever taken prescription
medications without a doctor’s order from 11.2% in 2014 to 10% by 2020 as measured by the Cabarrus
Youth Substance Use Survey.
Intermediate Objectives:
1. To reduce the percentage of teens that report that prescription medications are fairly easy or
very easy to get from 63% in 2015 to 58% in 2017 as measured by the Teen Medication Survey
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2. To decrease the percent of teens that believe there is no risk to slight risk associated with trying
someone else’s prescription medications once or twice from 32.6% in 2014 to 27% in 2017 as
measured by the Teen Medication Survey.
Short Term Objectives:
1. 1) To increase the percentage of people that dispose and store prescription properly from 14%
in 2015 to 16% in 2017 as measured by the Teen and Adult Medication Survey
2. 2) To decrease the percent of teens that agree or strongly agree that teens misuse prescription
medications to help them deal with problems from 62% in 2015 to 56% in 2017 as measured
by the Teen Medication Survey.
Date last updated: 4/22/15 Last update completed by: Jessye Brick and Kristin Klinglesmith
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Attachment A: Cabarrus Survey Instruments
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Attachment B:
Logic Model
