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Gloucester County Department of Health and Senior Services Division of Health Services Stephen M Sweeney, Freeholder Director Helene Reed, Freeholder Liaison Tamarisk Jones, Director Present:

Achieving a Healthier Gloucester County

A comprehensive Community Health Improvement Plan

February 2007 Gloucester County, New Jersey www.co.gloucester.nj.us

Table of Contents______________________________________

Executive Summary .................................................................................................... 3 The Planning Process.................................................................................................. 4 Public Health Assessment and Data Collection Methods ............................................ 6 Data Collection Results............................................................................................... 7 Development of Priorities .........................................................................................15 Priority Area 1: Increase Awareness of Existing Health Services ........................................................16 Priority Area 2: Encourage Regular Screenings and Checkups............................................................20 Priority Area 3: Promote Healthy Behaviors.... ..................................................................................27 Future Actions ...........................................................................................................35 Public Health Partnership...........................................................................................36

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Executive Summary_________________________________

The Gloucester County Department of Health and Senior Services, Division of Health Services is proud to present the 2007 "Achieving a Healthier Gloucester County" Community Health Improvement Plan (CHIP). The CHIP is part of a public health assessment process that is currently grant funded by the New Jersey Department of Health and Senior Services and the Centers for Disease Control and Prevention. Prior to development of the CHIP, the Gloucester County Department of Health and Senior Services completed the Assessment Protocol for Excellence in Public Health (APEXPH) in 2005. This assessment enabled the health department to evaluate the effectiveness of its programs through employee feedback. In 2005 following APEXPH completion, the Gloucester County Department of Health and Senior Services began a formal process to assess the health of the community. The Health Department established the "Achieving a Healthier Gloucester County" partnership, consisting of representatives from county agencies, hospitals, nonprofit agencies, faithbased groups, municipal boards of health, local universities, and schools as well as government leaders, healthcare providers and concerned citizens. Using a tool called MAPP (Mobilization for Action through Planning and Partnership), the Health Department collected data on the health of the community. The data was used to identify key issues affecting the health of Gloucester County residents. Once the key issues were identified, three priority areas were selected as areas for further action by the partnership. Priorities include: 1) Increase awareness of existing health services, 2) Encourage regular screenings and checkups, and 3) Promote healthy behaviors. Suggested activities for each of these priority areas have been incorporated into the CHIP. Following the release of the Community Health Improvement Plan, the partnership hopes to implement the activities listed in the CHIP and suggest new activities that will address the priority areas. As a stakeholder in the health of this community, we encourage you to continue the partnership's efforts in "Achieving a Healthier Gloucester County".

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The Planning Process

In 2005, the Gloucester County Department of Health and Senior Services began a formal, countywide public health assessment. The goal of the assessment was to identify areas that, if addressed, would improve the health of Gloucester County residents. It was decided that at the end of the assessment process, a Community Health Improvement Plan (CHIP) would be developed outlining priority areas for improvement and identifying activities that would address the priority areas.

__________________________

The MAPP Process

A tool was used in the development of the Community Health Improvement Plan. This tool is a process called Mobilizing for Action through Planning and Partnerships (MAPP). The MAPP process was developed by the National Organization of City and County Health Officials and has been used successfully in local health departments throughout the United States.

A core team from the Gloucester County Department of Health and Senior Services was assembled in 2005 to begin the formal public health assessment process. Using MAPP as a guide, the team identified the community partners with an interest in the health and welfare of Gloucester County residents. The team also agreed on the structure of the partnership and the purpose of partnership meetings.

4

The Planning Process___________________________________

A kickoff meeting was held on October 5, 2006 at the Pitman Golf Course to explain the purpose of the community health assessment, the MAPP process and the importance of the partnership. Members of the group discussed and agreed on the vision and mission of the "Achieving a Healthier Gloucester County" partnership. Plans for a follow up meeting were made to discuss methods of data collection for the public health assessment, which would in turn be used to identify the issues of greatest concern to the Gloucester County community.

Our Vision: To provide a healthier future for Gloucester County residents through community partnership and involvement.

Our Mission: The "Achieving a Healthier Gloucester County" partnership will assess and monitor the county's health needs and concerns, and develop plans that promote and improve the health of the community.

Following the initial meeting, a Steering Committee was convened to discuss the methodology for the communitywide assessment. The assessment methodology was approved by the entire partnership at a followup meeting held on March 2, 2006.

The goal of the public health assessment was to analyze the health status, concerns and behaviors of county residents along with the manner in which health services are delivered in Gloucester County.

5

Public Health Assessment and Data Collection Methods______

In order to understand the health needs of county residents and formally begin the assessment process, the Mobilizing for Action through Planning and Partnerships (MAPP) Process was used. Four assessments from MAPP were used to determine the types of data needed for the process. The assessments were done using a strategy approved by the partnership. Qualitative and quantitative data were collected and analyzed using the following data sources: · County and State Data · Community Survey · Interviews with Key Informants · Focus Groups The majority of data collected was obtained from the New Jersey Department of Health and Senior Services. Data was also made available from a "Community Health and Opinion Survey" that was distributed by the Gloucester County Department of Health and Senior Services to county residents. A total of 2,000 surveys were mailed to randomly selected households in the county. Surveys were mailed to households in all zip codes within the county based on the current proportion of households in each zip code. Out of 2,000 surveys mailed, 401 surveys were returned ­ a 20% response rate. Public health professionals throughout Gloucester County were selected as "key informants" and were asked to complete an inperson interview with Health Department staff. Focus Group sessions were held with local boards of health in Gloucester County. These participants were asked their opinions on health issues within their communities.

The Four MAPP Assessments: Community Themes and Strengths Local Public Health System Community Health Status Forces of Change

6

Data Collection Results__________________________________

According to 2005 U.S. Census estimates, approximately 276,000 residents live in Gloucester County. The county is comprised of 24 municipalities with populations ranging from approximately 50,000 (Washington Township) to 1,600 (Newfield). Currently considered New Jersey's fourteenth most populated county, Gloucester County experienced an 8.7% growth in population between 2000 and 2005.

Population of Gloucester County, by Age, 2005

45% 40% 35% 30% 25% 20% 15%

GC NJ US

The majority of Gloucester County residents are between 18 and 44 years of age. The median age of Gloucester County residents (37.2 years) is similar to the median age of New Jersey residents (38 years). Gloucester County has a lower percentage of seniors age 65 and older (11.3%) than New Jersey (12.5%) or the US (12.1%).

10% 5% 0%

Under 5 517 year s 1844 years 4564 years 65 and over

Source: U.S. Census. American Community Survey, 2005.

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Data Collection Results__________________________________

Population of Gloucester County, by Race, 2005

The majority of Gloucester County residents identify themselves as Caucasian (85.4%), followed by African American (9.7%) and Asian (2.1%). This varies from New Jersey, where 69.9% are Caucasian, 13.3% are African American and 7.3% are Asian. In Gloucester County, 3.1% of residents are Hispanic or Latino, compared to 15.3% of New Jersey residents.

90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Caucasian African American Asian Other Race More than One Race Hispanic/Latino GC NJ US

Source: U.S. Census. American Community Survey, 2005.

The majority of Gloucester County households (37%) have an income between $50,000 and $99,999. A lower percentage of Gloucester County households (17.9%) have an income of less than $25,000 compared to New Jersey (19.8%) and U.S. (26.9%) households. In 2005, the median income for Gloucester County residents was $64,484, higher than that of New Jersey ($62,672) and the U.S. ($46,242).

Population of Gloucester County, by Income, 2005

40% 35% 30% 25% 20% 15% 10% 5% 0% Less than $25,000 $2549,999 $5099,000 $100,00 and over

GC NJ US

Source: U.S. Census. American Community Survey, 2005.

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Data Collection Results _________________________________

Results of the community health assessment, including the "Community Health and Opinion Survey", show many advantages to living in Gloucester County. Some of the benefits include the following:

· Gloucester County has a wide variety of healthrelated services that are

available to county residents. Many public health and medical professionals in the county are dedicated to providing quality services that meet residents' health needs. In the 2006 "Community Health and Opinion Survey", 92% of survey respondents reported being satisfied with the care they receive from their doctors.

· In 2005, over 88% of Gloucester County residents list their overall health as

excellent, very good or good.

Self reported health among Gloucester County residents, 2005

40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Excellent Very Good Good Fair Poor Gloucester County NJ US

Source: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp Notes: Data taken from question: "How is your general health?"

· In 2005, it was estimated that 8% of county residents had no health insurance.

This remains significantly less than that of New Jersey (14.5%) and the US (also 14.5%).

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Data Collection Results _______________________________

Proportion of Residents with No Health Care Coverage, 2005

16% 14% 12% 10% 8% 6% 4% 2% 0% Gloucester County New Jersey US

8.0% 14.5% 14.5%

Source: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp Notes: Data taken from question: "Do you have health care coverage?"

· Deaths from heart disease have been steadily decreasing among Gloucester

County residents over the last decade. In 2003, the death rate due to heart disease reached an alltime low at 269 deaths per 100,000 population in Gloucester County.

Mortality Rates for Coronary Heart Disease, Gloucester County and New Jersey, 19902003

400

M ortality Rate (per 100,000)

350 300 250 200 150 100 50 2003 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 0

Glo ucester C o unty New Jersey

Source: New Jersey Department of Health and Senior Services, NJSHAD Query System. Notes: Ageadjusted rates are computed per 100,000 based on the 2000 standard population

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Data Collection Results _______________________________

· Many residents routinely get blood pressure and cholesterol checks to assess

their risk of heart disease. Results from the 2006 "Community Health and Opinion Survey" showed that 96% of survey respondents have had their blood pressure checked in the past year. Over 82% of Gloucester County residents have had their cholesterol checked in the past five years, compared to 77.6% of New Jersey residents and 73% of U.S. residents.

Percentage of Residents who had their Cholesterol checked in the past 5 years, 2005

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Gloucester County New Jersey US

% Checked last 5 years

% not checked last 5 years

Never Checked

Source: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp

· Gloucester County experiences a low rate of communicable diseases every

year. The number of communicable disease reports received by the Gloucester County Department of Health and Senior Services remains low. Additionally, the incidence rates of almost all reportable diseases are lower than that of New Jersey every year. Tuberculosis incidence rates have decreased in the past twenty years in New Jersey and the United States and have remained consistently low in Gloucester County. In 2005, the tuberculosis incidence rate in Gloucester County was 1.1 cases per 100,000 residents in New Jersey, 5.6 cases.

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Data Collection Results ______

________

Active Tuberculosis Incidence Rates for Gloucester County, New Jersey and the United States, 19862003.

14

TB Incidence Rate (per 100,000)

12

10

Gloucester County New Jersey

8

United St ates

6

4

2

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: New Jersey Department of Health and Senior Services, Communicable Disease Service, Tuberculosis Control Program CDC. Reported Tuberculosis in the United States, 2003. Atlanta, GA: U.S. Department of Health and Human Services, CDC, September 2005.

The prevalence of persons living with HIV/AIDS in Gloucester County was 116 cases per 100,000 residents, compared to 382 per 100,000 residents in New Jersey (as of June 30, 2006). The mortality rate due to HIV was less in Gloucester County than in the State of New Jersey, at 2.7 per 100,000 population in Gloucester County versus 9.4 per 100,000 population in New Jersey between 19992002 (Figure 3).

Mortality Rates due to HIV disease, Gloucester County and NJ, for selected years

Mortality Rate (per 100,000)

30 25 20 15 10 5 0 19911994 19951998 19992002

9.4 7.8 4.2 2.7 18.4 27.1

Gloucester County New Jersey

Source: New Jersey Department of Health and Senior Services, NJSHAD Query System. Note: Rates are ageadjusted and computed per 100,000 based on the Standard 2000 population.

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Data Collection Results _______________________________

The incidence rates of sexually transmitted diseases in Gloucester County remains lower than New Jersey, particularly for chlamydia and gonorrhea. In 2004, the number of new cases of chlamydia, gonorrhea and syphilis per 100,000 residents was lower in Gloucester County than in New Jersey.

Incidence Rates of Sexually Transmitted Diseases, Gloucester County and New Jersey, 2004

240

Incidence Rate (per 100,000)

200 160 120 80 40 0

200

145 Gloucester County New Jersey 80

41 2 chlamydia gonorrhea 9

syphillis

Source: New Jersey Department of Health and Senior Services, Infectious and Zoonotic Diseases Program, Communicable Disease Service.

· Many residents get a flu shot every year. The Gloucester County Department

of Health dispensed more than 23,000 free flu shots in 2006, in addition to those distributed by private physicians. In 2005, over 72% of Gloucester County residents over age 65 reported receiving a flu shot in the past year, which was higher than that of New Jersey and the United States.

Percentage of Adults ages 65 and older who have had a flu shot within the past year, 2005

100% 80% 60% 40% 20% 0% Gloucester County New Jersey U.S.

72.5% 63.4% 65.7%

Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System, SMART: Selected Metropolitan/ Micropolitan Area Risk Trends. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp

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Data Collection Results _______________________________

Deaths from influenza and pneumonia have consistently decreased over the last few years, due in part to the increase in influenza immunizations.

Mortality Rate due to Influenza and Pneumonia, Gloucester County and NJ, 19902003.

40

Mortality Rate (per 100,000)

35 30 25 20 15 10 5 2003 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 0

Glo ucester Co unty New Jersey

Source: New Jersey Department of Health and Senior Services, NJSHAD Query System.

· The teen birth rate has steadily decreased over the last decade. In 2003, the teen

birth rate was 18.8 live births per 1,000 agespecific female population. In New Jersey, the teen birth rate was 25.5 in the U.S. it was 41.6.

Teen Birth Rate (among 1519 year old females), Gloucester County, New Jersey and the United States, 19942003

70

Teen Birth Rate

60 50 40 30 20 10 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 0

Gloucester County New Jersey United States

Sources: New Jersey Center for Health Statistics U.S. Department of Health and Human Services, National Center for Health Statistics, National Vital Statistics System. National Vital Statistics Reports. Volume 54 (2). "Births: Final Data for 2003".

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Development of Priorities ______________________________

In addition to highlighting the positive areas of the health of Gloucester County residents, the data collection also showed areas that could be improved. Analysis of county and State data, results of the Community Health and Opinion survey and information from the key informant interviews and focus groups led to the development of health priorities in Gloucester County. Using data collection from the public health assessment, the Community Health Improvement Plan has identified three priority areas that the public health partnership can address. Priority Areas for Improvement

1. Increase Awareness of Health Services and Resources 2. Encourage Regular Screenings and Checkups 3. Promote Healthy Behaviors

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Priority Area 1: Increase Awareness of Existing Health Services_____________

Many health services and resources are available in Gloucester County. Despite this, some residents may not be aware that these services exist, or may not know how to find these resources. Also, staff from public health organizations throughout the county may not be aware that these resources exist and therefore cannot recommend them to their clients.

Key informant comments: "An obstacle...is communication ­ getting the word out about education and outreach programs in our area." "We need an easy way to look for services within the county." "The public has difficulty accessing services and finding ways to get information about available programs." "People are unaware of the services offered by the Gloucester County Health Department." "We need to increase advertising for health education and health promotion programs." "We estimate that 35% of the population that is eligible for our program don't know they are eligible."

Results of the key informant interviews as well as the municipal board of health focus groups have identified the need for increased awareness about the available services and resources within the county. Fourteen of the twentythree key informants mentioned the need to increase awareness about health related services and resources available throughout Gloucester County.

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Priority Area 1: Increase Awareness of Existing Health Services_____________

Residents who completed the "Community Health and Opinion Survey" were asked to indicate whether they wanted to learn more about or participate in certain services and programs if they were available. According to the survey, Gloucester County residents were most interested in information about nutrition, weight loss and exercise programs. Other areas of interest were free or low cost medical, dental or prescription programs and cancer screenings. Fewer residents were interested in mental health counseling, stopsmoking programs and drug and alcohol counseling.

Percentage of Survey Respondents Interested in Select Programs and Services, 2006

60%

50%

40% 44% 30% 36% 28%

20%

10% 11% 8% 0% Nutrition/W eight Loss/Exercise Free of low cost Cancer Screenings medical, dental or prescription coverage Mental Health Counseling Stop Smoking Programs 4% Drug and Alcohol Counseling

Residents that completed the "Community Health and Opinion Survey" were given a chance to rank their community concerns as "not a concern", "moderate concern" or "serious concern". Respondents listed obesity, illegal drug use, cancer, air quality, tobacco use and heart disease among their greatest concerns.

Percentage of Survey Respondents listing Issues as "Serious" or "Moderate" Concerns

100% 80% 60% 40% 20% 0%

Obesity Illegal Drug Use Cancer Air Quality Tobacco Use Heart Disease

72% 62% 59% 59% 59% 55%

Sources for both tables: "Community Health and Opinion Survey" done by the Gloucester County Department of Health and Senior Services, 2006.

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Priority Area 1: Increase Awareness of Existing Health Services____________

The graphs on the previous page point to areas that may be of greatest interest or concern to Gloucester County residents. Focusing on services that address the areas of greatest interest or concern ­ nutrition/weight loss, health care coverage, cancer screenings, drug and tobacco use ­ may be a good starting point to increase awareness about these services.

In summary, assuring that the residents of Gloucester County are aware of existing services and resources is a priority. Although many residents do use available services in the county, some are unaware of important health services that can assist them. Additionally, staff from healthrelated agencies are sometimes unaware of services provided by other agencies within the region.

Developing coordinated strategies to educate the public about resources will help keep them informed and change the misconceptions about eligibility. In addition, by stressing the issues that are of greatest concern to residents, we can maximize public interest and participation.

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Priority Area 1: Increase Awareness of Existing Health Services_____________

Suggested Activities to Address this Priority Area: 1. Increase awareness of existing health related services and resources by gathering and maintaining a comprehensive directory of information on available programs and resources throughout Gloucester County. 2. Develop a means to easily dispense this information on a regular basis to health and social service providers throughout the county. 3. Develop an outreach and marketing strategy to dispense this information to county residents, businesses and existing organizations.

Available Resources: 1. The "211" call system is a tollfree phone number that residents and professionals can utilize to learn about healthrelated services, programs and resources available in the county. 2. The Gloucester County website is a resource that informs county residents of existing programs within the county. 3. The Gloucester County Newsletter is mailed on a regular basis to every household in the county. The newsletter highlights various services that are available to county residents. 4. Both of Gloucester County's hospitals and other organizations within the county have newsletters with information on available resources. 5. Local businesses, through their human resources or employee health departments, have programs to educate their employees on available services.

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Priority Area 2: Encourage Regular Screenings and Checkups_______________

Results of the public health assessment have identified health maintenance as a priority in the community. The inability to manage health conditions, or the lack of early diagnosis for certain conditions, may be a strong risk factor for morbidity and mortality in the county.

One of the most important ways to maintain health is through regular checkups and screenings. This includes maintenance of physical health through preventative measures such as cancer screenings, blood pressure, cholesterol and blood sugar screenings, and dental visits. Health maintenance also includes the awareness of the importance of stress, anxiety and other mental health issues upon overall health.

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Priority Area 2: Encourage Regular Screenings and Checkups _____

_____

The control of cancer is an important issue for Gloucester County residents, as it is for many people living in the United States. In Gloucester County, the most recent data shows that the highest cancer incidence rates, or rates of new cancer cases, include cancers of the breast, prostate, lung and colon.

Cancer Incidence Rates, Gloucester County and New Jersey, by Type of Cancer, 19992003

250

Incidence Rate (per 100,000)

200

150

Gloucest er Count y New Jersey

100

50

0

B reast (Female) Prostate Lung and Colon and M elanoma bronchus rectum of the skin B ladd er Non Hod gkins lymphoma Ovary Leukemia Pancreas Oral cavit y and pharynx

Source: New Jersey Department of Health and Senior Services, Division of Cancer Epidemiology Services. Available at: http://www.cancerrates.info/nj/ Note: Ageadjusted incidence rates are computed per 100,000 based on the 2000 standard population.

Cancer is the second leading cause of death in Gloucester County. The highest mortality rates occur from cancers of the lung, prostate, breast and colon.

Mortality Rates due to Specific Cancers, Gloucester County and New Jersey, 19992003

80 70 M ortality Rates (per 100,000) 60 50 40 30 20 10 0

Lung and Prostate Bronchus Breast Colon and Pancreas (female) rectum Ovary Leukemia Non Bladder Brain and Melanoma Oral Hodgkins nervous cavity and lymphoma system pharynx Gloucester County New Jersey

Source: NJDHSS, Division of Cancer Epidemiology Services. Available at http://cancerrates.info/nj/njmort.html Note: Rates are ageadjusted and are computed per 100,000 based on the 2000 standard population.

21

Priority Area 2: Encourage Regular Screenings and Checkups _____

_____

Regular cancer screening may lead to earlier cancer detection for some of these cancers. Timely screening, diagnosis and followup may ultimately lead to an improved chance for cancer survival. Some key informants who were interviewed stressed the importance of cancer screenings for Gloucester County residents. Key Informant Comments: "One of the most pressing issues for the community is early screenings for cancer." "Patients should advocate for more cancer screenings." "Free cancer screenings are underutilized."

22

Priority Area 2: Encourage Regular Screenings and Checkups ________

Ageadjusted Mortality Rates for Coronary Heart Disease, Gloucester County and New Jersey, 19902003

400

Mortality Rate (per 100,000)

350 300 250 200 150 100 50 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Gloucester County New Jersey

Glo ucest er Co unty N ew Jersey

The first and third leading causes of death in Gloucester County are heart disease and stroke. Overall, mortality rates from heart disease and stroke have been slightly higher than those of New Jersey.

0

Source: New Jersey Department of Health and Senior Services, NJSHAD Query System. Notes: Ageadjusted rates are computed per 100,000 based on the 2000 standard population

This may indicate that residents have more difficulty managing their heart conditions or are diagnosed with their heart condition too late.

Mortality Rate (per 100,000)

Ageadjusted Mortality Rates for Stroke, Gloucester County and New Jersey, 19902003

70 60 50 40 30 20 10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

0

Source: New Jersey Department of Health and Senior Services, NJSHAD Query System. Notes: Ageadjusted rates are computed per 100,000 based on the 2000 standard population

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Priority Area 2: Encourage Regular Screenings and Checkups __________

25% of county residents have been told by a doctor that they have high blood pressure.

According to the American Heart Association, some of the major risk factors of heart disease are high cholesterol, high blood pressure, and diabetes. Regular blood pressure, cholesterol and blood sugar screenings, as well as regular doctor visits to manage heart disease, may improve health outcomes related to heart disease and stroke.

33% of county residents have been told by a doctor that their cholesterol is too high.

Almost 20% of county residents have never had their cholesterol checked. Dental Health Regular checkups include dental visits. Making regular visits to the dentist is another way to ensure good health. In the 2006 "Community Health and Opinion Survey", 85% of survey respondents with dental insurance reported visiting a dentist within the past year. Lack of dental coverage is a leading cause for failing to see a dentist regularly. It is important to refer these patients to free or low cost services.

According to the 2006 "Community Health and Opinion Survey", 41% of Gloucester County residents who responded to the survey currently have no dental insurance.

Source for facts: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfss smart/SelMMSAPrevData.asp

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Priority Area 2: Encourage Regular Screenings and Checkups ______ _____

Mental Health Paying attention to mental health is an important way to maintain health. Almost half of the survey respondents reported that they often feel stressed and are affected by stress. A smaller proportion report more serious mental health issues. Communication Managing health involves being able to effectively communicate with healthcare providers. Some key informants stressed not only seeing a healthcare provider on a regular basis, but knowing what to ask during the doctor visit. Access to Care Receiving regular checkups and screenings is only possible if all members of the public have a regular source of medical care. Approximately 8% of county residents do not have health insurance. In these instances, the referral to free or reduced fee medical providers is necessary.

Percentage of Survey Respondents Addressing Questions on Mental Health, 2006

100%

80%

60%

48% 48%

40%

23%

20%

12%

0% Often feel stressed Feel that stress from job/responsibilities affects their health Often feel depressed Have been to doctor in past year for mental health reasons

Source: "Community Health and Opinion Survey" done by the Gloucester County Department of Health and Senior Services, 2006.

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Priority Area 2: Encourage Regular Screenings and Checkups ________

Suggested Activities to Address this Priority Area:

1. Continue to promote and publicize existing services that provide free or low cost screenings. 2. Develop educational resources to promote regularly scheduled screenings, such as cancer screenings, blood pressure tests, cholesterol tests, and routine doctor and dental exams. The educational resources will list strategies for individuals to address physical and mental health with their healthcare provider. 3. Develop a plan to distribute these educational resources to the public via healthcare providers, local businesses, nonprofit agencies and social service organizations.

Available Resources: 1. The Cancer Education and Early Detection (CEED) program through Underwood Hospital offers free cancer screenings for certain types of cancers. 2. The Gloucester County Department of Health and Senior Services provides free blood pressure and cholesterol screenings at various sites throughout the county. 3. Many county businesses have employee wellness and community outreach programs that provide or encourage screenings and checkups. 4. Two Federally Qualified Health Care satellite centers are currently located in Gloucester County: Community Health Care in Glassboro and CAMcare Health Corporation in Paulsboro. Both provide routine and preventative care to uninsured and underinsured families. 5. NJ FamilyCare provides health insurance for children and families. 6. The Gloucester County Prescription Savings Program provides lowcost prescription drug coverage to Gloucester County residents.

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Priority Area 3: Promote Healthy Behaviors

_______

_____

_

All of the key informants who were interviewed identified healthy behaviors as major contributors to positive health outcomes. Key informants listed a wide range of unhealthy behaviors as some of the most pressing issues for the community. Healthy behaviors include proper nutrition practices such as eating a diet low in fat and full of fruits and vegetables as well as getting enough exercise. Other healthy behaviors include avoiding alcohol, tobacco and other drugs, taking medications as prescribed, and engaging in safe sexual practices. Based on the results of the public health assessment, the priority health behaviors to be encouraged include:

· Eating a Healthy Diet · Participating in Regular Exercise · Quitting Smoking or Avoiding

Smoking

27

Priority Area 3: Promote Healthy Behaviors: Proper Diet and Exercise

The behaviors that were discussed most often by the key informants as behaviors to avoid were those associated with obesity among adults and children. Maintaining a healthy weight can lower the risk of developing long term health conditions. Individuals who are overweight and obese are at increased risk for diseases such as:

· · · · · · · · ·

_

High Blood Pressure Type 2 Diabetes Coronary Heart Disease Stroke Gallbladder Disease Osteoarthritis Sleep Apnea Respiratory Problems Some Cancers

Percentage of Persons by weight classification, 2003

45 40 35

Gloucester County New Jersey US

Percentage

30 25 20 15 10 5 0 % neither overweight or obese % overweight % obese

Consistent with nationwide trends, the proportion of people who are overweight or obese has been increasing steadily in Gloucester County and New Jersey. Data shows that Gloucester County has a higher proportion of persons that are overweight and obese (64%) when compared to New Jersey (57%) or to the United States (60%).

Source: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp

28

Priority Area 3: Promote Healthy Behaviors: Proper Diet and Exercise

_

Percentage of Persons who are Overweight, 2006

100% 80% 60% 40% 20% 0% Are actually overweight Believe they are overweight

64% 53%

Although 64% of Gloucester County residents are currently overweight, only 53% of residents consider themselves overweight.

Source: "Community Health and Opinion Survey" done by the Gloucester County Department of Health and Senior Services, 2006.

Eating Patterns of Gloucester County residents, 2006

100%

80%

An important factor in maintaining healthy weight is diet. Limiting fast food and increasing fruit and vegetable consumption are two ways to improve nutrition.

60%

40%

20%

27% 21%

0% Eat 5 or more servings of fruits or vegetables daily Eat fast food more than once per week

Source: "Community Health and Opinion Survey" done by the Gloucester County Department of Health and Senior Services, 2006.

Only 27% of Gloucester County residents surveyed met the U.S. Department of Health and Human Services and the U.S. Department of Agriculture recommendation of eating 5 or more servings of fruits and vegetables daily.

Additionally, approximately one out of five county residents who were surveyed reported eating fast food more than once per week.

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Priority Area 3: Promote Healthy Behaviors: Proper Diet and Exercise__

The increased promotion and visibility of healthy eating practices and exercise may be well accepted by Gloucester County residents. Results from the "Community Health and Opinion Survey" in 2006 showed that many Gloucester County residents are currently trying to lose weight and may be interested in information that may help them lose or control their weight. 59% of survey respondents tried to lose weight in the past year.

44% of survey respondents wanted more information on nutrition, weight loss and exercise.

According to the survey, 59% of Gloucester County residents tried to lose weight in the past year. Of those residents who considered themselves overweight: 82% tried to lose weight within the past year 56% wanted more information on nutrition, weight loss and exercise. Of the twenty three key informants who were interviewed, over half listed obesity related behaviors as a pressing issue or as a health behavior that needs to be addressed.

Of those survey respondents who considered themselves overweight, 82% tried to lose weight in the past year and 56% wanted information on nutrition, weight loss and exercise programs.

Key informant quote: "Our sedentary lifestyles and lack of exercise is the most important health issue it is the reason for many of the health problems that people face today."

Source for facts: "Community Health and Opinion Survey" by the Gloucester County Department of Health and Senior Services, 2006.

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Priority Area 3: Promote Healthy Behaviors: Proper Diet and Exercise__

Suggested Activities to Address this Priority Area: 1. Identify current antiobesity initiatives throughout the county. Support a countywide work group to discuss best practices from current programs and potential partnerships in this area. 2. Increase marketing and promotion of current programs aimed at encouraging healthy lifestyles through proper diet and exercise. 3. Increase education efforts in the areas of diet and exercise.

Available Resources:

1. "Families on the Move" which is a diet and exercise program geared toward families with children is a free program provided by the Gloucester County Department of Health. 2. The Gloucester County Cancer Coalition has a "Healthy Lifestyles" committee that seeks to promote and encourage nutrition and exercise. 3. The YMCA of Gloucester County provides a widevariety of health and fitness programs to it's over 4000 members. 4. Gloucester County has many parks, bike trails, and walking paths. There are sports leagues of every type available for residents of all ages.

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Priority Area 3: Promote Healthy Behaviors: Smoking Cessation

Tobacco use, particularly smoking, remains the number one cause of preventable disease and death in the United States. Smoking has been linked to a wide range of serious illnesses, including cancer, heart disease and respiratory disorders. Smoking can also worsen the symptoms of other conditions, such as osteoporosis or asthma. By encouraging smokers to quit and preventing people from starting to smoke, we can improve health outcomes for Gloucester County residents. The percentage of Gloucester county residents who reported smoking in 2003 was 23.5% (18.3% smoke everyday and 5.2% smoke some days), compared to 19.3% of New Jersey residents and 21.7% of U.S. residents. Smoking has consistently been shown to be a leading cause of lung cancer. Statistics shows that Gloucester County, along with the southern portion of the State, possesses a higher incidence of lung cancer than other regions of the State. This may be attributed to the higher smoking rates evidenced in this geographic area.

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_____

Percentage of Gloucester County Residents who Reported Smoking, 2003

70 60 50

Percentage

40 30 20 10 0 Smoke Everyday Smoke some days Former smoker Never smoked

Gloucester County New Jersey US

Source: Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System Select Metropolitan/ Micropolitan Statistical Area Health Risk Data. Available at: http://apps.nccd.cdc.gov/brfsssmart/SelMMSAPrevData.asp

Priority Area 3 ­ Promote Healthy Behaviors: Smoking Cessation

_

Smoking Cessation among Gloucester County Residents

100%

Of those Gloucester County residents who currently smoke, 67% have tried or are currently trying to quit. This suggests that although many smokers are motivated to quit, they may be unaware of the available resources that can help them permanently quit.

80%

60% 47% 40% 20% 22% 31%

20%

0%

Tried to quit

Currently trying to quit

Never tried to quit

Want information about smoking cessation

Source: "Community Health and Opinion Survey" done by the Gloucester County Department of Health and Senior Services, 2006.

The percentage of Gloucester County women who smoked during pregnancy was consistently higher than New Jersey women across all age groups. This may be a particular group who would benefit from programs that address smoking cessation.

Percentage of Women who Smoked during Pregnancy, by Age Group, 19992003 Combined

60% 50% 40% 30% 20% 10% 0% 1519 years 2024 years 2529 years 3039 years 4044 years

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics.

Gloucester County New Jersey

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Priority Area 3: Promote Healthy Behaviors: Smoking Cessation

_____

_

Suggested Activities to Address this Priority Area: 1. 2. Continued enforcement of New Jersey's Smoke Free Air Act. Continued enforcement of the tobacco age of sale laws through the New Jersey Tobacco Age of Sale Enforcement (TASE) program. Actively promote use of New Jersey QUITLINE and NJ QUITNET. These free services provide cessation advice, counseling, and support for smokers looking to quit.

3.

Available Resources: 1. 2. 3. Gloucester County Health Department currently enforces the Smoke Free Air Act and tobacco age of sale regulations. Resources from New Jersey QUITLINE, New Jersey QUITNET and Rowan University smoking cessation programs. The Southwest Council sponsors the REBEL program, an antitobacco advocacy group that works to discourage youth from smoking.

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Future Actions__________________________________

The development of the "Achieving a Healthier Gloucester County" Community Health Improvement Plan was a process that required the participation of many public health partners throughout the county. We wish to thank the members of the Steering Committee and the "Achieving a Healthier Gloucester County" partnership for their involvement in this initiative. We would also like to thank those individuals who served as key informants and members of various focus groups. The CHIP has listed three priority areas as areas to be addressed by the public health community. The suggested activities under each priority area are a starting point and may change as the partnership plans, implements and evaluates these activities over the next few years. Future efforts will focus on the identification and recruitment of corporate, institutional and nonprofit agency partners within the county who will work with the "Achieving a Healthier Gloucester County" partnership to implement these programs and activities within their organizations. To become involved in the "Achieving a Healthier Gloucester County" partnership or for more information about the Community Health Improvement Plan, contact Robert Bamford, Partnership Coordinator at the Gloucester County Department of Health and Senior Services, (856)2624101.

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Public Health Partnership_____________________________

Robert Bamford Gloucester County Department of Health and Senior Services Richard Bellamente Underwood Memorial Hospital Don Benedik Gloucester County Department of Health and Senior Services Terry Brooks Robins Nest Inc. Liz Bowker Virtua Health Karen Bozar Ovall Rowan University De Burgess Glassboro Community Health Inc. Gwen Brown City of Woodbury Nelson Carasquillo Comite de Apoyo a los Trabajadores Agricoles (CATA) Rachel Cano Virtua Health Sharon Ceravolo GC School Nurses Association Suzanne Champion Harrison Township Board of Health Hilary Colbert Community Planning & Advocacy Council Becky Corbin United Way of Gloucester County Deborah Cornelius Robins Nest Inc. Bonnie Dann City of Woodbury Joe Devine Kennedy Memorial Hospital Jane DiBella Woolwich Township Board of Health Anthony DiFabio Robins Nest Inc. Janet Drew Underwood Memorial Hospital James Edwards Community Healthcare Nancy Edwards Underwood Hospital Maria Erdman Gloucester County Department of Health and Senior Services Alvin Garlic City of Woodbury Richard Gaydos Gloucester County Department of Human Services John Girardi Glassboro Board of Health Paula Gordy Virtua Health Lisa Little Gloucester County Cancer Coalition Sherri Hilt Samaritan Hospice Lea Hernandez Kennedy Memorial Hospital Jere Hoffner United Way of Gloucester County Pamela Negro Rowan University Kathleen Mahmoud Gloucester County Department of Health and Senior Services Jeanne McBride Rutgers University Dr. James McCabe Kennedy Memorial Hospital Mary McCormick Kennedy Memorial Hospital Dan McFadden New Jersey Department of Health and Senior Services Fran McFarland Rowan University Kimberly McKownStrait Famcare Inc. Susan Micklos Kennedy Memorial Hospital Demond Miller Rowan University Marybeth Monroe Municipal Alliance Jean Mouch Medical Mission Sisters

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Public Health Partnership

Elizabeth Moody New Jersey Department of Health and Senior Services Dr. Josette Palmer Gloucester County Department of Health and Senior Services Mark Parker YMCA of Gloucester County Kay Peters Incarnation Church Debbie Pine Elk Township Dr. Nancy Pontes Rowan University Yvonne Purdue Virtua Health Lillian Quillian National Park Board of Health Pat Rossiter National Park Board of Health

_______

Lucy Stetter Pitman Board of Health Kathleen Spinossi Gloucester County Department of Health & Senior Services Nancy Sullivan Gloucester County Department of Health and Senior Services Judy Tanger Deptford Library Board Linda Tramo Deptford Board of Health Dr. Howard Weinberg South Jersey Heart Group Joe Williams The Southwest Council Inc. Scott Woodside Gloucester County Department of Health and Senior Services Anthony Zapposodi Mantua Board of Health *Names in bold denote members of the Steering Committee

Chester Randall South Harrison Board of Health Jim Rhynard Glassboro Board of Health Andrew Robertson Gloucester County REBEL Gloria Salter Glassboro Board of Health Don Schneider Gloucester County Department of Health and Senior Services Evelyn Scholl The Southwest Council Inc. Dr. Robert Schwartz Internal Medicine Associates of Southern NJ Lynn Silverstein American Red Cross Marie Sparacio Rowan University

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