Joan M. Gray-UMDNJ Fieldwork Project
Presentation to
Camden City Healthy Futures Committee
September 28, 2006

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

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

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






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

 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

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
96
94
92
90
88
86
84
82
80
2001 2001
Camden
City
Camden
County
New
Jersey
NJ Target
Preferred
Endpoint

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
14
12
10
8
18
16
4
2
0
6
2001 Targets
Camden City
Camden County
NJ
Target NJ White
Target NJ Black
TargetNJ Hispanic
Target NJ Asian/PI
Target NJ

Fundamentals of Good Health
Healthy Mothers and Young Children
14
Percentage of infants with birth weights less than
2,500 grams
12
10
Sources:
 NJDHSS, Center for Health Statistics
 Healthy New Jersey 2010: Update
2005


Camden Kids Count 2004
Healthy Camden City 2010: Update
2005
8
6
4
2
Camden City
Camden County
NJ
Target-NJ White
Target-NJ Black
Target-NJ Hispanic
Target-NJ Asian/PI
Target NJ
0
2002 Target

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
30
20
10
0
70
60
50
40
90
80
2002 Target
Camden City
Camden County
NJ
Target NJ White
Target NJ Black
Target NJ Hispanic
Target Asian/PI
Target NJ

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
3
2.5
2
1.5
1
0.5
0
2002 Target
Camden City
Camden County
NJ
Target-NJ White
Target-NJ Black
Target-NJ Hispanic
Healthy NJ Target
Preferred Endpoint

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
96
94
92
90
88
86
84
82
80
78
2002 Target
Camden City
Camden County
NJ
Target-NJ White
Target-NJ Black
Target-NJ Hispanic
Healthy NJ Target
Preferred endpoint

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
4.5
3.5
3
4
2.5
1.5
2
0.5
1
0
2000 2001 2002 2003 Target
Camden City
Target black
Target Hispanic
NJ Target

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
60
50
40
30
20
10
0
90
80
70
2000 2001 2002 2003 Target
Camden City
Target White
Target Black
Target Hispanic
NJ Target

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
200
180
160
140
120
100
80
60
40
20
0
2000 2001 2002 2003 Target
Camden City
Target White
Target Black
Target Hispanic
NJ Target

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
60
50
40
30
80
70
20
10
0 neither overweight obese
Camden City
Camden County
Target neither
NJ Target-overweight

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
70
60
50
40
30
20
10
0
2005
Camden City
Camden County

Preventing Major Diseases
Heart Disease and Stroke
Age-adjusted mortality rate from coronary heart disease per
100,000 standard population
250
200
150
Sources:
 NJDHSS, Center for Health Statistics,
 Healthy New Jersey 2010: Update 2005
 Healthy Camden City 2010: Update 2005
100
50
0
1999 2000 2001 2002 2003 Target
Camden City
New Jersey
NJ Target

Preventing Major Diseases
Heart Disease and Stroke
Age-adjusted mortality rate from cerebrovascular diseases per 100,000 standard population
60
50
40
Sources:



NJDHSS, Center for Health Statistics
Healthy New Jersey 2010: Update 2005
Healthy Camden City 2010: Update 2005
30
20
10
0
1999 2000 2001 2002 2003 Target
Camden City
New Jersey
NJ Target

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
82
80
86
84
78
76
74
72
90
88
70
2003 Camden
Data
Target
Camden City
Camden County
New Jersey
Target
Preferred Endpoint

Preventing/Reducing Major Diseases
Cancer
Age-adjusted mortality rate from female breast
30 cancer per 100,000
25 standard female
20 population
15
Sources:
 NJDHSS, Center for Health Statistics.
 US Census Bureau


Healthy New Jersey 2010-Update 2005
Healthy Camden City 2010: Update 2005
10
5
0
2002 2003 Target
Camden City
NJ
NJ Target

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
15
10
25
20
5
0
Average
1998-2002 target
Camden City
Camden County
NJ Target

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
30
25
20
15
10
5
0
2003 2002 Target
Camden City
NJ
NJ Target

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.
35
30
25
20
15
10
5
0
1999 2000 2001 2002 2003
Camden City

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)
30
25
20
15
50
45
40
35
10
5
0
1999-
2001
2000-
2002
NJ
Target
15-19
Camden City males
25-34 rate/100,000
NJ Target 15-19

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

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
60
50
40
30
20
10
0
2003 Camden
Data
Target
Camden City
Camden County
New Jersey
Target

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
96
94
92
90
88
86
84
82
80
78
2002 Target
Camden City
Camden County
NJ
Target-NJ White
Target-NJ Black
Target-NJ Hispanic
Healthy NJ Target
Preferred endpoint

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.
35
30
25
20
15
10
5
0
1999 2000 2001 2002 2003
Camden City

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
700
600
500
400
300
200
100
0
2003 Targets
Camden City
Target NJ
Target NJ White
Target NJ Black
Target NJ Hispanic

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
30
25
20
15
10
5
0
1999 2000 2001 2002 2003 Target
Camden City
New Jersey
NJ Target

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
8
6
12
10
4
2
0
2000 Target
Camden City
New Jersey
Target White
Target Black
Target Hispanic
Target Asian/PI
Target NJ

Preventing/Reducing Major Diseases
Sexually Transmitted Diseases
Incidence of chlamydia trachomatis infections among females aged 15-
19 years per 100,000 population
2,500
2,000
1,500
Sources:
 NJDHSS, Communicable Disease Service.
 Healthy New Jersey 2010: Update 2005
 U.S. Census Bureau
 Healthy Camden City 2010: Update 2005
Recent Datanot exactly comparable as
Camden data includes all ages however this is age group with highest target rate.
1,000
500
0
2004 Target 950
Camden City
New Jersey
Target NJ

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

Focus Group In-Depth Analysis

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

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”

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.”

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.”

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.”

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 failingbad 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.”

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.”

Violence/Safety
#4 most frequently discussed





“The drug dealers are responsible for most of the murders and driveby 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.”

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.”

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.”

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.”

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

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

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

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

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

Next Steps