1. Summation of Recent Camden City Health Studies Joan M. Gray-UMDNJ Fieldwork Project Presentation to Camden City Healthy Futures Committee September 28, 2006

2. Purpose of the Report Combine some of the recent Camden studies into a usable format for setting health initiatives Benchmark Camden City objectively against New Jersey health targets

3. Acknowledgments This report has been made possible through the support of: The Camden City Healthy Futures Committee Mitchell Berger, MPH Camden County Department of Health and Human Services Dr. Jung H. Cho Camden County Department of Health and Human Services Hilary Colbert MPA CPAC: Community Planning and Advocacy Council Jean F. Mouch, MD, MPH Camden County Cancer Coalition Derek Ziegler CAMConnect

4. Acknowledgements University of Medicine and Dentistry of New Jersey Mark Fulchomer, Ph.D Marcia Sass, Sc.D., MSN. Bernadette West, Ph.D., MA., University of Medicine and Dentistry-School of Public Health Students Ann Jones, MBA, BS, MPH Maribeth Robenolt, BA

5. Studies Included New Jersey Department of Health and Senior Services, Center for Health Statistics Behavioral Risk Factor Surveillance Survey-BRFSS Camden City Breakdown-2006 UMDNJ MPH Fieldwork Project Camden City Community Health Assessment Focus Group Project-2005 UMDNJ MPH Class Project Camden City Community Health Assessment Focus Group In Depth Analysis Using Atlas.ti-2006 UMDNJ MPH Fieldwork Project Healthy Camden City 2010-Update 2005 UMDNJ MPH Fieldwork Project

6. Studies Reviewed Camden Hospital and Emergency Room Health Data June 2006 Camden Coalition of Healthcare Providers and CAMConnect Camden Kids Count 2004 Association for Children of NJ and CAMConnect Camden Waterfront South Air Toxics Pilot Project 2005 NJ Dept of Environmental Protection From Data to Strategy: Information for Planning a Smoking Cessation Program-2005 Camden County Cancer Coalition Health Report Card Survey-2005 Center for Children & Childhood Studies at Rutger’s Camden, Cooper University Hospital Department of Family Medicine, and CAMConnect

7. Access to Health Care Percentage of adults who report they have a source or primary care Sources: NJDHSS, Center for Health Statistics,, Behavioral Risk Factor Survey Healthy New Jersey 2010: Update 2005 Camden City and Camden County Data from Behavioral Risk Factor Survey Breakdown- UMDNJ Graduate Student Project. 2006 Healthy Camden City 2010: Update 2005

8. Fundamentals of Good Health Healthy Mothers and Young Children Rate of infant mortality per 1,000 live births Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count 2004 Healthy Camden City 2010: Update 2005

9. Fundamentals of Good Health Healthy Mothers and Young Children Percentage of infants with birth weights less than 2,500 grams Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count 2004 Healthy Camden City 2010: Update 2005

10. Fundamentals of Good Health Healthy Mothers and Young Children Percentage of live births whose mothers receive prenatal care in the first trimester Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count 2004 Healthy Camden City 2010: Update 2005

11. Fundamentals of Good Health Healthy Mothers and Young Children Percentage of live births whose mothers receive no prenatal care Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count Healthy Camden City 2010: Update 2005

12. Fundamentals of Good Health Healthy Mothers and Young Children Percentage of women who abstain from any tobacco product during pregnancy Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count Healthy Camden City 2010: Update 2005

13. Fundamentals of Good Health Healthy Behaviors-Adolescents Total number of births per 1000 females aged 10 through 14 Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 National Center for Health Statistics and U.S. Census Bureau Healthy Camden City 2010: Update 2005

14. Fundamentals of Good Health Healthy Behaviors-Adolescents Total number of births per 1000 females aged 15 through 17 Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 National Center for Health Statistics and U.S. Census Bureau Healthy Camden City 2010: Update 2005

15. Fundamentals of Good Health Health Behaviors-Adolescents Total number of births per 1000 females aged 18 through 19 Sources: NJDHSS, Center for Health Statistics. US Census Bureau Healthy New Jersey 2010-Update 2005 National Center for Health Statistics and US census Bureau Healthy Camden City 2010: Update 2005

16. Fundamentals of Good Health Healthy Behaviors: Adult Percentage of persons aged 18 and over who are overweight but not obese Sources: NJDHSS, Center for Health Statistics, Behavioral Risk Factor Surveillance System. Camden City and Camden County Data from Behavioral Risk Factor Survey Breakdown- UMDNJ Graduate Student Project. 2006 Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

17. Fundamentals of Good Health Preserving Good Health for Seniors Percentage of persons 65 years and older who have received influenza vaccinations in the previous 12 months Sources: NJDHSS, Center for Health Statistics, Behavioral Risk Factor Surveillance System Camden City and Camden County Data from Behavioral Risk Factor Survey Breakdown- UMDNJ Graduate Student Project. 2006 Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005 Data not precisely comparable as Camden City and Camden County Data include all ages

18. Preventing Major Diseases Heart Disease and Stroke Age-adjusted mortality rate from coronary heart disease per 100,000 standard population Sources: NJDHSS, Center for Health Statistics, Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

19. Preventing Major Diseases Heart Disease and Stroke Age-adjusted mortality rate from cerebrovascular diseases per 100,000 standard population Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

20. Preventing Major Diseases Heart Disease and Stroke Percentage of persons 18 years of age and over who have had their blood cholesterol checked by a health professional within the past five years Sources: NJDHSS, Center for Health Statistics, Behavioral Risk Factor Survey Healthy New Jersey 2010: Update 2005 Camden City and Camden County Data from Behavioral Risk Factor Survey Breakdown-UMDNJ Graduate Student Project. 2006 Healthy Camden City 2010: Update 2005

21. Preventing/Reducing Major Diseases Cancer Age-adjusted mortality rate from female breast cancer per 100,000 standard female population Sources: NJDHSS, Center for Health Statistics. US Census Bureau Healthy New Jersey 2010-Update 2005 Healthy Camden City 2010: Update 2005

22. Preventing/Reducing Major Diseases Cancer Age-adjusted incidence rate of invasive cervical cancer in females per 100,000 standard population Sources: NJDHSS, Cancer Epidemiology Services. Camden County Cancer Coalition, February 2006 Healthy New Jersey 2010-Update 2005 Healthy Camden City 2010: Update 2005

23. Preventing/Reducing Major Diseases Cancer Age-adjusted mortality rate from colorectal cancer per 100,000 standard population Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

24. Preventing/Reducing Major Diseases Cancer Age-adjusted mortality rate from lung cancer among persons 65 years of age and over per 100,000 population Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Camden Demographics, Camden Reports 2006, CAMConnect Healthy Camden City 2010: Update 2005 Not graphed as comparison due to skewing of data due to Camden’s age spread in population with 37% under 18yrs of age.

25. Preventing/Reducing Major Diseases Mental Health Mortality rate from suicide per 100,000 male population \ Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005 ****Camden City data indicate age group of concern is 25-34 years of age. Different age group than Healthy New Jersey 2010 (15-19)

26. Preventing/Reducing Major Diseases Mental Health Additional Information 1 in 45 Camden Residents visited the ER in 2004 with a diagnosis of drug abuse. Camden Hospital and Emergency Room Health Data 2003, Camden Coalition of Health Care Providers, CAMConnect June 2006 24% of residents in Camden report their mental health was not good more than 2 days during the past 30 days. 14% of residents in Camden report their mental health was not good 15-30 days of the last 30 days. Healthy NJ benchmark-Mental health good average of 28 days out of last 30. Camden City and Camden County Data from Behavioral Risk Factor Survey Breakdown-UMDNJ Graduate Student Project. 2006 Healthy NJ 2010-2005 Update

27. Preventing/Reducing Major Diseases Addictions Prevalence of cigarette smoking among the population aged 18 and over Sources: NJDHSS, Center for Health Statistics, New Jersey Behavioral Risk Factor Survey. Healthy New Jersey 2010: Update-2005 Camden City and Camden County Data from High Risk Area Behavioral Risk Factor Survey Breakdown-UMDNJ Graduate Student Project. 2006 Healthy Camden City 2010: Update 2005

28. Fundamentals of Good Health Healthy Mothers and Young Children Percentage of women who abstain from any tobacco product during pregnancy Sources: NJDHSS, Center for Health Statistics Healthy New Jersey 2010: Update 2005 Camden Kids Count Healthy Camden City 2010: Update 2005

29. Preventing/Reducing Major Diseases Cancer Age-adjusted mortality rate from lung cancer among persons 65 years of age and over per 100,000 population Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Camden Demographics, Camden Reports 2006, CAMConnect Healthy Camden City 2010: Update 2005 Not graphed as comparison due to skewing of data due to Camden’s age spread in population with 37% under 18yrs of age.

30. Preventing/Reducing Major Diseases Asthma Annual hospital admission rate due to asthma per 100,000 population Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Camden City data source-Camden Hospital and Emergency Room Health Data 2003, Camden Coalition of Health Care Providers, CAMConnect June 2006 Healthy Camden City 2010: Update 2005

31. Preventing/Reducing Major Diseases HIV/AIDS Age-adjusted mortality rate from HIV disease per 100,000 population Sources: NJDHSS, Center for Health Statistics. Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

32. Preventing/Reducing Major Diseases Infectious Diseases Tuberculosis incidence rate per 100,000 population Sources: NJDHSS, Communicable Disease Service. Healthy New Jersey 2010: Update 2005 Healthy Camden City 2010: Update 2005

33. Preventing/Reducing Major Diseases Sexually Transmitted Diseases Incidence of chlamydia trachomatis infections among females aged 15- 19 years per 100,000 population Sources: NJDHSS, Communicable Disease Service. Healthy New Jersey 2010: Update 2005 U.S. Census Bureau Healthy Camden City 2010: Update 2005 Recent Data-not exactly comparable as Camden data includes all ages however this is age group with highest target rate.

34. Top Priorities Identified in Community Focus Groups Issues of poverty and the working poor, lack of housing, jobs, education Healthcare concerns (particularly men’s health, mental health, exercise, and affordability) Concerns regarding safety, drugs, domestic violence, and after school safety Concerns related to families and children, parenting skills

35. Focus Group In-Depth Analysis Topics Most Frequently Discussed

36. Health Care Access #1 Most Frequently Discussed Comments No coverage for prescriptions Negative effect of poverty on ability to maintain good health practices Lack of access to specialists, dentists, psychologists, psychiatrists, and substance abuse programs Lack cars or money for bus transportation especially to specialists “Difficult to get appointments at WIC”, “Difficult to fill out Family Care applications” Long waits No insurance if working poor-2 part time jobs

37. Children/Families #2 Most Frequently Discussed Comments “The family structure is failing” “Poverty causes parents to participate in illegal activities to provide for their families” “Unsafe to let children go out and play” “Children are not eating properly.” “ Many children eat potato chips or pretzels for breakfast” “Children look up to drug dealers. They are the ones with the gold jewelry and BMWs”

38. Children/Families #2 Most Frequently Discussed (cont.) Comments (continued) “We are losing a generation of boys” to the terrible drug thing. “Children buying drugs are more often arrested than the people dealing drugs.” “Children no longer go to church or attend Bible School.”

39. Schools and Education #3 most frequently discussed Comments “Many children move from school to school during the year and from year to year.” “There is too much violence in the schools.” “Schools should provide extensive sex education. They should show them how babies are born and how demanding it is to take care of a baby.”

40. Schools and Education #3 most frequently discussed “School supplies are always late.” “Teachers are no longer just educators. They have to deal with all of society’s problems. There are so many disruptive children that it is difficult to teach.” “People also need to be educated how to manage their money. They need to make their paycheck last till the next one and not spend it all right away.”

41. Schools and Education #3 most frequently discussed “Kids need to walk 2-3 miles to get to school. They need to reevaluate the bus pass situation.” “The schools never follow up to see if the parent has received the report card. They give no warning if your child is failing- bad communication.” “Child misses a lot of school due to health problems (asthma).” “Some schools are so big that the children get lost.” “There should be education programs for people wanting to start-up businesses in Camden-things like the legalities of incorporating and financing.”

42. Violence/Safety #4 most frequently discussed Comments Violence and safety for children “at school and on the way to school.” “Young mothers are not monitored and the safety of their infants could be jeopardized.” “Police need to learn to differentiate between individuals who are truly violent versus those who are acting out due to mental illness.” “Seniors are afraid to leave their homes. They are disrespected by the youth.”

43. Violence/Safety #4 most frequently discussed “The drug dealers are responsible for most of the murders and drive-by shootings” “Guns are too readily available and there is little the police do to get rid of the guns” “In Camden children can’t run if confronted. If you run away you’re punk and everyone beats you up. You need to be prepared to be violent to protect yourself.” “It is dangerous outside of the business district” “People working at agencies where client visits are necessary are often afraid to leave the office.”

44. Violence/Safety #4 most frequently discussed “Inadequate employment and housing for ex-cons has led to a high recidivism and incarceration rate. People convicted of crimes are not eligible for a lot of the programs out there.” “There is actually a war going on outside that you can’t run from and no one is safe from.” “There are a lot of gangs. The gangs are becoming more organized.” “Very rarely do individuals come out of prison changed for the better.” “There is physical and verbal violence on the street and at home. Many sexual assaults occur in the home.”

45. Violence/Safety #4 most frequently discussed “The drug activity is escalating during the day and even moving into the medical and academic areas.” “Some in law enforcement will accept being paid off by the drug dealers.” “They are doing a lot to beautify the parks but not secure them. The parks are now nicer for the drug dealers and prostitutes.” “Many have just accepted the violence in Camden.” “Oh well, Camden is violent….This is not acceptable though. It would not be accepted in any other community.”

46. Environmental #5 most frequently discussed Comments “The water quality is terrible.” “I wouldn’t drink it or wash my children in it. I bathe them in bottled water” “The water is brown coming out of the spigot and the toilets always look dirty, but it’s the water color.” “The air is not clean and we still have problems with lead.” “Unsanitary conditions cause many health problems like asthma.” “There are infestations of water bugs.”

47. Results of Environmental Studies Camden Waterfront South Air Toxics Pilot Project 2005 NJ Dept of Environmental Protection

48. Waterfront South Air Pollutants Currently above Health Benchmarks Pollutants with risk ratios greater than one Currently above Health Benchmarks Arsenic, Cadmium, Dioxin, Nickel- cancer the health effect of concern Lead-irreversible neurological and behavioral deficits in children, cancer Hydrogen sulfide-adverse effects of nasal tract, headache and nausea Manganese-visual reaction, eye-hand coordination, hand steadiness Camden Waterfront South Air Toxics Pilot Project 2005 NJ Dept of Environmental Protection

49. Waterfront South Air Pollutants Currently above Health Benchmarks Fine Particulate Matter PM 25 risk ratio 1.5 Inhalable Particulate Matter PM 10 risk ratio 1.2 Diesel Particulate Matterrisk ratio 1.4 Camden Waterfront South Air Toxics Pilot Project 2005 NJ Dept of Environmental Protection

50. Summary of Challenges Camden City High Utilization of Emergency Departments versus primary care Infant mortality, prenatal care, and teen pregnancies in Camden City Obesity Heart Disease, Asthma, Diabetes Cancer particularly breast, colorectal, invasive cervical, and lung mortality. Oral and prostate incidence levels.* Mental Health Infectious Disease * From Data to Strategy: Information for Planning a Smoking Cessation Program-2005 Camden County Cancer Coalition

51. Summary (continued) Cigarette smoking Dental care Poverty, housing, jobs, education, working poor Healthcare (particularly men’s health, mental health, exercise, and affordability) Safety, drugs, domestic violence, and after school safety Schools and education Lack of specialists, money for transportation to specialists out of area, money for prescriptions Environmental-air, water, infestations

52. Next Steps 1. Ranking Priorities 2. Developing Action Plans to Address Priorities