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COMMUNITY HEALTH ASSESSMENT City of Newark NJ

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					 CITY OF NEWARK


COMMUNITY HEALTH
   ASSESSMENT
City of Newark - Community Health Assessment
Updated: February 2007


                               CITY OF NEWARK
                         COMMUNITY HEALTH ASSESSMENT

                                              TABLE OF CONTENTS


CURRENT CAPACITY.................................................................................................... 1
    1. Demographic Characteristics................................................................................ 1
              Population.................................................................................................. 1
              Gender (Sex) ............................................................................................. 1
              Age ............................................................................................................ 1
              Race/Ethnicity............................................................................................ 2
    2. Socioeconomic Characteristics............................................................................. 4
              Income ....................................................................................................... 4
              Education................................................................................................... 5
              Language................................................................................................... 5
              Foreign Born/Citizenship............................................................................ 7
    3. Community Partnerships ...................................................................................... 8
    4. Availability of Funding Resources......................................................................... 9

CONTRIBUTORS TO HEALTH STATUS ..................................................................... 11
    5. Quality of Life Indicators ..................................................................................... 11
               Employment............................................................................................. 11
               Environment............................................... Error! Bookmark not defined.
    6. Barriers Affecting Access to Services................................................................. 12
               Lack of Health Insurance ......................................................................... 12
    7. Utilization of Health Resources and Services ..................................................... 13
    8. Behavioral Risk Factors...................................................................................... 13
               Physical Activity ....................................................................................... 14
               Obesity..................................................................................................... 15

HEALTH STATUS ......................................................................................................... 16
    Addictions ................................................................................................................ 16
    Asthma..................................................................................................................... 17
    Cancer ..................................................................................................................... 19
               Prostate Cancer....................................................................................... 22
    Child and Adolescent Health.................................................................................... 24
               Smoking among Adolescents .................................................................. 24
               Drug Use among Adolescents ................................................................. 24
               Births to Teenage Mothers....................................................................... 25
               Mortality Due to Homicide........................................................................ 26
    Diabetes................................................................................................................... 27
    Environmental Health............................................................................................... 29
City of Newark - Community Health Assessment
Updated: February 2007


               Childhood Lead Poisoning ....................................................................... 29
    Heart Disease and Stroke........................................................................................ 30
               Hypertension/Cardiovascular Disease ..................................................... 30
               Stroke (Cerebrovascular Disease)........................................................... 30
    HIV/AIDS ................................................................................................................. 33
    Infectious Diseases.................................................................................................. 37
               Tuberculosis ............................................................................................ 37
               Childhood Immunizations......................................................................... 37
    Maternal and Infant Health....................................................................................... 39
               Prenatal Care........................................................................................... 39
               Low Birthweight ....................................................................................... 40
               Infant Mortality ......................................................................................... 40
    Mental Health........................................................................................................... 42
    Oral Health............................................................................................................... 42
    Sexually Transmitted Diseases................................................................................ 43
    Mortality - Leading Causes of Death........................................................................ 44

EMERGENCY PLAN..................................................................................................... 49

REFERENCES.............................................................................................................. 51
City of Newark - Community Health Assessment
Updated: February 2007                                                            Page 1




                          CURRENT CAPACITY

1.       Demographic Characteristics

Population

The population of Newark is 280,666 estimated as of July 1, 2005, up from 273,546 as
of the 2000 Census. Newark accounts for 35% of Essex County’s population and 3.3%
of New Jersey’s population.


                                                Population
                                  April 1, 2000    July 1, 2005   Change 2000-2005
     Newark                            273,546         280,666         7,120    2.6%
     Essex County                      793,633         791,057        -2,576   -0.3%
     New Jersey                     8,414,350        8,717,925       303,575    3.6%
     United States                281,421,906      296,410,404    14,988,498    5.3%
     Source: U.S. Census Bureau




Gender (Sex)

There is a higher percent of females than males living in Newark – at 53.6% females
versus 46.4% males. These differences exist in other jurisdictions. However, the
percent of males in the Newark population is less than in New Jersey (48.6% male and
51.4% female) and in the US (49.0% male and 51.0% female) (Census, 2005).


Age

The population in Newark is younger than that of the state or nation. As of July 1, 2005
the median age of Newark residents is 30.1 years, compared to the New Jersey median
age of 38.0 years and the United States median of 36.4 years (Census, 2005).

The distribution by age category in the table and figure below underscore these age
differences, which have implications for delivery of services in Newark.
City of Newark - Community Health Assessment
Updated: February 2007                                                                                                          Page 2




                  Population by Age Category – July 1, 2005
        Age Category             Newark    New Jersey        US
        Under age 18              30.4%       25.3%         25.4%
        18 years and over         69.6%       74.7%         74.6%
        21 years and over         65.2%       71.2%         70.9%
        62 years and over         11.0%       15.4%         14.7%
        65 years and over          8.5%       12.5%         12.1%
        Source: Census Bureau. 2005 American Community Survey.




                     Distribution of Population by Age in Newark, NJ, US
                                        - July 1, 2005

 18%
                                                                                                                     Newark
 16%                                                                                                                 New Jersey
                                                                                                                     United States

 14%


 12%


 10%


  8%


  6%


  4%


  2%


  0%
       < Age 5   Age 5-9   Age 10-   Age 15-   Age 20-   Age 25-   Age 35-   Age 45-   Age 55-   Age 60-   Age 65-    Age 75-   Age 85+
                             14        19        24        34        44        54        59        64        74         84




Race/Ethnicity

The population of Newark has a high proportion (87%) of racial/ethnic minorities. Half
of residents are Black/African American (not Hispanic) and one third are Hispanic/Latino
(any race). These differences have to be considered when planning and delivering
services to residents of Newark.
City of Newark - Community Health Assessment
Updated: February 2007                                                                                                                   Page 3




                              Population by Race/Ethnicity - July 1, 2005

    70%                                                                                                          66.8%
                                                                   63.0%

    60%


           50.6%
    50%



    40%

                                     32.9%

    30%



    20%
                                                                                   15.3%                                         14.5%
                     12.5%                                 12.8%                                         11.9%
    10%                                                                    8.8%
                                                                                                                         6.8%
                             4.1%


    0%
                        Newark                                     New Jersey                                    United States

                   Black/African American (Not Hispanic)   White (Not Hispanic)   Other (Not Hispanic)   Hispanic/Latino (any race)

`
City of Newark - Community Health Assessment
Updated: February 2007                                                                                        Page 4



2.     Socioeconomic Characteristics

Income

The median household income in Newark in 2005 was $30,655, up from $26,913 in
1999 (reported in the 2000 Census). However, this income level was only 50% of the
statewide median and two-thirds of the national median household income. These
differences indicate the need for additional, coordinated services.


                           Income in 1999 (2000 Census)*                               Income in 2005**
                          Median          Median          Per             Median            Median            Per
                         Household        Family         Capita          Household          Family           Capita

Newark                     $26,913        $30,781       $13,009               $30,665      $34,816         $15,346
New Jersey                 $55,146        $65,370       $27,006               $61,672      $75,311         $31,471
United States              $41,994        $50,046       $21,587               $46,242      $55,832         $25,035
Newark as a % of:
   New Jersey                49%            47%           48%                  50%           46%              49%
   United States             64%            62%           60%                  66%           62%              61%
Source: *U.S. Census Bureau. Census 2000. ** 2005 American Community Survey




Consistent with income data, rates of poverty are higher in Newark. One quarter of
Newark residents – and one third of Newark’s children - were living below poverty in
2005. These rates have declined since 1999 (2000 Census).


                                Percent of Residents Living Below Poverty
                                  1999 (2000 Census)*                                    2005**
                                               Children                                           Children
                                 Total         < Age 18                        Total              < Age 18

     Newark                      28.4%              36.9%                      24.8%               31.5%
     New Jersey                   8.5%              11.1%                      8.70%              11.80%
     United States               12.4%              16.6%                     13.30%              18.50%
     Source: *U.S. Census Bureau. Census 2000. ** 2005 American Community Survey
City of Newark - Community Health Assessment
Updated: February 2007                                                                                            Page 5



Education

Two thirds of Newark residents age 25 and older are high school graduates or higher,
and nearly one in eight (12.6%) have a bachelor’s degree or higher.



                                        Education - Age 25 and Older (2005)

                    90%
                                                             86.3%                           84.2%

                    80%


                    70%
                          64.7%

                    60%
 % Adults Age 25+




                    50%


                    40%
                                                                      34.2%
                                                                                                          27.2%
                    30%


                    20%
                                      12.6%
                    10%


                    0%
                              Newark                           New Jersey                      United States

                                  High School Graduate or Higher            Bachelor's Degree or Higher




Language

Over half of Newark residents age 5 and older speak only English in the home. Nearly
one third speak Spanish at home, another 13.5% speak other languages and less than
1% speak Asian/Pacific Islander languages or other languages. In contrast, nearly
three quarters of New Jersey residents speak only English at home. This means that
services to Newark residents must consider these language differences.

Just as important, nearly one quarter (24.3%) of Newark residents said they did not
speak English very well including those who spoke only English at home. This rate is
twice as high as New Jersey (11.5%) and the US (8.6%). Services to Newark residents
must also address literacy in and understanding of the English language.
City of Newark - Community Health Assessment
Updated: February 2007                                                                       Page 6



           Language Spoken At Home (Age 5+) in 2005

                                Newark
                                2.5%                             English only
                             0.8%                                Spanish
                    13.5%                                        Other Indo-European languages
                                                                 Asian and Pacific Islander languages
                                                                 Other languages




                                                         52.2%



            31.0%




                  New Jersey                                      United States
                                                                               0.8%
                    4.3% 1.2%                                           2.9%
                                                                 3.7%
           8.4%

                                                         12.0%




 13.5%




                                               72.6%

                                                                                          80.6%




Source: Census Bureau. 2005 American Community Survey.
City of Newark - Community Health Assessment
Updated: February 2007                                                                             Page 7



Foreign Born/Citizenship

Over 70% of Newark’s population is native born in the United States and 30% are
foreign born. Nearly 20% of New Jersey’s population is foreign born, higher than 12%
across the US.

Of the native born Newarkers, nearly 6% were born in Puerto Rico and the U.S. islands,
twice as high as 2.3% statewide and 1.2% nationwide.

Of the 30% of Newark’s foreign born population (nearly 76,000), 10% are naturalized
U.S. citizens (25,000) and 20% are not U.S. citizens (51,000).



                              Native and Foreign Born Population - 2005

                       100%

                                                                                      12.4%
                       90%                               19.5%
                              29.8%
                       80%


                       70%
  % Total Population




                       60%


                       50%

                                                                                      87.6%
                       40%                               80.5%
                              70.2%
                       30%


                       20%


                       10%


                        0%
                              Newark                   New Jersey                  United States

                                         Native Born                Foreign Born
City of Newark - Community Health Assessment
Updated: February 2007                                                               Page 8



3.       Community Partnerships
There are numerous community partners and health care providers which are available
to Newark residents. These are summarized below.

     •   Hospitals/health care systems. There are five acute care hospitals in Newark,
         within three major state health care systems. These systems have inpatient and
         outpatient clinic services, including family health care services.
     •   Federally qualified health centers (FQHC) – There are two FQHCs in Newark -
         one with four clinic sites in Newark and one serving homeless individuals at five
         clinics (Special Care Clinic at DHHS office and four homeless shelter-based
         clinics).
     •   Community based clinics – a number of community based organizations
         (CBOs) provide medical and health services at local sites, including CBOs
         serving the Hispanic/Latino population.
     •   School based health services – Newark Public Schools has school based
         clinics at all schools – elementary, middle and high school – throughout Newark.
     •   Health insurers – a number of health insurance

In addition, thirty seven (37) agencies and 55 individuals have participated in health
planning for the Community Health Assessment and Community Health Improvement
Plan. These are listed below.


Above The Rim Inc. of Newark                     Healthy Mothers Healthy Babies of
American Cancer Society/Newark                      Essex Inc.
   Cancer Initiative                             Horizon Blue Cross Blue Shield of New
Americhoice                                         Jersey
Amerigroup                                       Horizon NJ
ASPIRA of NJ                                     Integrity House
Catholic Health & Human Services                 International Youth Organization
Connie Dwyer Breast Center                       La Casa De Don Pedro
C.U.R.A.                                         NAACP-Newark Chapter
El Club Del Barrio                               New Community Corporation
Essex County Cancer Coalition/St.                New Jersey Association of Corrections
   Michael’s Hospital                            Newark Beth Israel Medical Center
Essex County College                             Newark Community Health Center
Focus Community Health Center                       (CHC)
Gateway Northwest Maternal & Child               Newark Emergency Services for
   Health Network                                   Families Inc.
Grace Reformed Baptist Church                    Newark Public Schools
                                                 Newark Renaissance House
City of Newark - Community Health Assessment
Updated: February 2007                                                            Page 9


New Jersey Institute of Technology              Saint Michael’s Medical Center
New Jersey Medical School                       Statewide Parent Advocacy Network
Northern New Jersey Maternal Child              The Leaguers Inc.
  Health Consortium                             Tri-City Peoples Corporation
Police Institute of Rutgers -The State          Unified Vailsburg Services Organization
  University of New Jersey                      United Community Corporation
Prudential Insurance Co.                        University Hospital
Rutgers - The State University of New           UMDNJ
  Jersey                                        WISOMMM



4.    Availability of Funding Resources
A wide array of funding resources is available to support health care and related
services. However, because the cost of health care is so high state- and nationwide
and health problems are complex and interrelated with social and economic issues, the
amounts are often not sufficient to cover the cost of care for all residents.

Private health insurance provided primarily by employers is still the largest payment
source for health care. However, the rates of such coverage are lower in Newark than
statewide due to higher rates of unemployment. Nonetheless, the major financial,
government, education, and health care institutions in Newark provide coverage for their
employees, many of whom are Newark residents.

Medicaid is health insurance for very low income individuals and families who are
“categorically eligible”. Those who receive Temporary Assistance to Needy Families
(TANF) or Supplemental Security Income (SSI) also receive Medicaid. Medicaid is a
significant source of health care for Newark residents and revenue for Newark hospitals
and other providers.

New Jersey Family Care (NJFC) is available for lower income children whose family
incomes exceed Medicaid limits or whose families are not eligible for Medicaid. The
number of beneficiaries and amount of assistance to Newark residents is unknown.
However, many health care providers and CBOs assist families in applying for NJFC.

Medicare pays for health insurance mostly for individuals age 65 and older who have
been employed and have contributed to the Social Security system. (It is for this reason
that lack of health insurance is measured for adults under age 65.)

Charity Care. The New Jersey Hospital Care Payment Assistance Program (Charity
Care Assistance) is free or reduced charge care which is provided to patients who
receive inpatient and outpatient services at acute care hospitals throughout the State of
New Jersey. Hospital assistance and reduced charge care are available only for
necessary hospital care. Some services such as physician fees, anesthesiology fees,
City of Newark - Community Health Assessment
Updated: February 2007                                                           Page 10


radiology interpretation, and outpatient prescriptions are separate from hospital charges
and may not be eligible for reduction. The source of funding for hospital care payment
assistance is through the Health Care Subsidy Fund administered under Public Law
1997, Chapter 263 (NJDHSS, 2006).

For State Fiscal Year 2007 (July 1, 2006 – June 30, 2007), a total of $155.6 million in
charity care was allocated for hospitals in Newark. This is 27% of the total $583.4
million charity care allocation (NJDHSS, 2007).

Other Sources. Other federal and state sources fund health and medical programs for
Newark residents. Over $3 million is available through the FQHC for medical care for
uninsured residents. Over $2 million is available for health care for homeless
individuals. Over $2 million of the federal Ryan White Title I program funds medical
care for residents with HIV/AIDS, and an additional $3 million supports related health
services and case management. Other HIV/AIDS funding supports medical care for
women and children and for special services.
City of Newark - Community Health Assessment
Updated: February 2007                                                                             Page 11




                       CONTRIBUTORS TO
                        HEALTH STATUS

5.        Quality of Life Indicators

Employment

Employment and unemployment rates are related to the socioeconomic factors of
income and education above. In 2005, the civilian labor force in Newark ranged from
104,266 to 117,736. A range of 8,685 to 13,260 Newark residents in the labor force
were unemployed in 2005.

The two sources of recent employment data show that rates of unemployment in
Newark were higher than New Jersey and the United States.

This factor is important for health planning because employment is the chief source of
health insurance. Higher rates of unemployment (lower rates of employment) mean
relatively less employer-provided health insurance. Individuals and families must rely
on other sources, including government insurance programs, or go without health
insurance. This directly affects access to health care and health.


                         Labor Force and Unemployment in 2005
                            USDOL – BLS                                    Census – 2005 ACS
                   Civilian     Unemployment                         Civilian       Unemployment
                 Labor Force Number     Rate                       Labor Force Number       Rate
Newark               104,266              8,685            8.3%       117,736     13,260              11.3%
New Jersey         4,430,373            194,436            4.4%     4,389,993    276,753               6.3%
United States    149,320,000          7,591,000            5.1%   146,576,413 10,117,603               6.9%
Source:          U.S. Dept. Labor. Bureau of Labor Statistics     Census Bureau. 2005 American Community Survey
City of Newark - Community Health Assessment
Updated: February 2007                                                                        Page 12




                                     Unemployment Rates in 2005

  12%
                                                               11.3%


  10%


                  8.3%
   8%
                                                                                       6.9%
                                                                           6.3%
   6%
                                         5.1%
                             4.4%
   4%




   2%




   0%
                             2005*                                         2005**

                              Newark              New Jersey           United States
2005* = U.S. Dept. Labor, Bureau of Labor Statistics
2005** = Census Bureau. 2005 American Community Survey




6.      Barriers Affecting Access to Services
As shown in 3. Community Partners, there is an adequate supply of health resources
within the 26 square miles of the City of Newark.

Lack of Health Insurance

The lack of health insurance or method to pay for health care is the chief barrier which
affects access to health care and related services. This barrier was underscored
through the Community Forums conducted in 2005-2006 in the five wards of Newark
and the numerous focus groups among specific populations. Residents rely on
Medicaid or charity care, which may not cover all needed health services or which
provide only partial payment for services rendered. As a result, they postpone or forgo
needed health care, until the medical condition required acute care and admission via
the emergency department.
City of Newark - Community Health Assessment
Updated: February 2007                                                             Page 13


An estimated 16.9% of New Jersey residents under age 65 were uninsured in 2005
(Census, 2006). Applying this rate to Newark yields an estimated 42,000 uninsured
residents under age 65. Adjusting for the higher rate of poverty in Newark yields an
estimate of 60,000 or nearly 25% Newark residents under age 65 who are uninsured.

Other Factors

Residents in the community forums and focus groups identified other factors which were
barriers to accessing services. These factors include long waits for appointments or to
see a physician if appointments are scheduled, lack of information about services,
perceived lack of access or proximity, language and cultural barriers, lack of time spent
by medical personnel with the patients, particularly in explaining diagnoses and follow
up care, lack of money to pay for needed medications.




7.     Utilization of Health Resources and Services
Utilization of health resources and services is difficult to determine. Most data are
available from individual health care providers in Newark.

In terms of the total hospital admissions (discharges), a total of 65,890 Newark
residents were discharged from hospitals statewide in 2004.




8.     Behavioral Risk Factors
Personal health behaviors play a major role in premature morbidity and mortality,
particularly from chronic diseases. Surveys collecting data on actual behaviors, rather
than on attitudes or knowledge, are especially useful for planning, initiating, supporting,
and evaluating health promotion and disease prevention programs. The Centers for
Disease Control and Prevention (CDC) established the Behavioral Risk Factor
Surveillance System (BRFSS), designed to collect state-level data across the U.S.,
nation. CDC developed standard core questionnaire for states to use to provide data
that could be compared across states. The BRFSS, administered and supported by the
Division of Adult and Community Health, National Center for Chronic Disease
Prevention and Health Promotion, CDC, is an ongoing data collection program (CDC,
2007).

The primary focus of these surveys has been on behaviors and conditions that are
linked with the leading causes of death—heart disease, cancer, stroke, diabetes, and
injury—and other important health issues. These behaviors and conditions include
City of Newark - Community Health Assessment
Updated: February 2007                                                            Page 14




      •   Not getting enough physical activity.
      •   Being overweight.
      •   Not using seatbelts.
      •   Using tobacco and alcohol.
      •   Not getting preventive medical care - such as flu shots, mammograms, Pap
          smears, and colorectal cancer screening tests - that can save lives.

A number of states from the outset stratified their samples to allow them to estimate
prevalence for regions within their respective states. Data on some behavioral risk
factors is available for Essex County, which can be applied to Newark.

Newark DHHS is developing a BRFSS which will survey Newark residents in 2007
about a variety of risk factors. The samples will be statistically valid for the City,
enabling more targeted planning. In the interim, county and regional data for the
Newark-Union Metropolitan Area can be used to estimate behavioral risk factors for
Newark.

Physical Activity

In 2005, nearly e third (32.5%) of Essex County residents age 18 and older did not
exercise within a given month (BRFSS SMART, 2006). Applying this rate to Newark, an
estimated 64,000 Newark residents age 18 and older did not exercise in a given month.
City of Newark - Community Health Assessment
Updated: February 2007                                                                     Page 15



Obesity

Obesity is an increasing problem across the US, New Jersey, and Newark. The BRFSS
is one method to measure overweight and obesity, based on demographics and Body
Mass Index (BMI) computed using weight and height. BMI of 25 to 29.9 is considered
overweight and BMI of 30+ is considered obese (CDC, 2006).

It is estimated that in 2005, 59.2% of adults in New Jersey were either overweight
(37.1%) or obese (22.1%) (CDC, 2006). Applying these rates to Newark yields a
minimum of 117,000 of residents age 18+ who are overweight or obese. Adjusting for
demographics increases this number to 130,000, or two thirds of Newark adults.



          Estimated Percent of Adult Population (Age 18+) Overweight
                                or Obese - 2005

 70%            66%
                                               59%                             61%
 60%


               27.0%
 50%
                                              22.1%                           24.4%


 40%



 30%



 20%           38.9%                          37.1%                           36.7%


 10%



  0%
               Newark                       New Jersey                     United States

                        Overweight (BMI 25-29.9)         Obese (BMI 30+)
City of Newark - Community Health Assessment
Updated: February 2007                                                            Page 16




                         HEALTH STATUS

Addictions
Substance abuse and its related problems are among society’s most pervasive health
and social concerns. Substance abuse, which includes the problematic consumption or
illicit use of alcoholic beverages, tobacco products and drugs (including the misuse of
prescription drugs), affects all racial, ethnic and income groups, and results in
substantial morbidity and mortality, as well as contributing to crime and other social and
economic problems.

The prevalence of addictions is difficult to estimate. However, one indicator of the
extent of addictions is indicated by admissions to drug treatment services. In 2005,
4,533 Newark residents were admitted to treatment for substance use which is 8.5% of
the state total. This could indicate a disproportionate impact because the rate nearly
three times the percent of New Jersey’s population living in Newark (3.3%), or could
also reflect more access to treatment in Newark and the Essex County area due a high
number of treatment facilities in the greater Newark area.

The primary drug used in Newark differs fro New Jersey. Heroin and opiates accounts
for three quarters of drug treatment admissions among Newark residents, versus less
than half statewide. Likewise, treatment of alcohol abuse accounts for one quarter of
statewide admissions but only 8% of Newark admissions.




                  Substance Abuse Admissions By Primary Drug
                     January 1, 2005 To December 31, 2005
                                           Heroin &                Other/
                     Alcohol    Cocaine    Opiates    Marijuana   Unknown       Total
Newark
  Number                376        353       3,340       354        110         4,533
  Percent              8.3%       7.8%       73.7%      7.8%       2.4%        100.0%
Essex County
  Number               811         587       5,295       616        198         7,507
  Percent             10.8%       7.8%       70.5%      8.2%       2.6%        100.0%
New Jersey
  Number              14,402     5,928      23,654      6,954      2,367       53,305
  Percent             27.0%      11.1%      44.4%       13.1%      4.4%        100.0%
City of Newark - Community Health Assessment
Updated: February 2007                                                             Page 17




               Distribution of Drug Treatment Admissions in 2005 by
                       Substance - Newark, Essex County, NJ

 80%


 70%


 60%


 50%


 40%


 30%


 20%


 10%


  0%
           Alcohol         Cocaine       Heroin & Opiates    Marijuana     Other/Unknown

                            Newark       Essex County       New Jersey




Asthma
Asthma is a disease that affects the lungs. It is one of the most common long-term
diseases of children. It causes repeated episodes of wheezing, breathlessness, chest
tightness, and nighttime or early morning coughing. Asthma can be controlled by
following a medical management plan and by avoiding contact with environmental
“triggers,” such as cockroaches, dust mites, furry pets, mold, tobacco smoke, and
certain chemicals (CDC).

Socioeconomic status, particularly poverty, appears to be an important contributing
factor to asthma illness, disability, and death. In the United States, the rate of asthma
cases for nonwhites is only slightly higher than for whites, yet the death, hospitalization,
and ED-visit rates for nonwhites are more than twice those for whites. Although
reasons for these differences are unclear, they likely result from multiple factors: high
levels of exposure to environmental tobacco smoke, pollutants, and environmental
allergens (for example, house dust mites, cockroach particles, cat and dog dander, and
possibly rodent dander and mold); a lack of access to quality medical care; and a lack of
City of Newark - Community Health Assessment
Updated: February 2007                                                         Page 18


financial resources and social support to manage the disease effectively on a long-term
basis (Healthy People 2010).

Asthma prevalence. Asthma prevalence among adults (age 18+) has increased
statewide in 2004. Approximately 7.5% of adults in New Jersey have been told that
they currently have asthma, and 11.7% have ever been told they have asthma (lifetime
asthma). This computes to approximately 17,000 Newark adults currently with asthma
and 26,000 who have had asthma at some time in their life.

The 2005 New Jersey Youth Risk Behavior Survey reports that, statewide, 20.1% of
high school students age 15 to 18 and 19.1% of middle school students age 12 to 14
had been diagnosed with asthma at some time in their life (NJ Dept. Education).
Applying these rates to Newark yields approximately 5,700 Newark children age 12 to
18 who have been diagnosed with asthma.

Hospital admissions. In 2004, 1,538 Newark residents were hospitalized for asthma.
One in four (375) was a child under age 5. The percent of hospitalizations of African
American residents (61.6%) is slightly higher than their percent in the general
population (50.2%) indicating a slight disproportionate impact.


     Newark Resident Hospitalizations for Asthma in 2004 by Race/Ethnicity
                                                  #            %
                 NonHispanic White                73         4.7%
                 NonHispanic Black               948        61.6%
                 Hispanic                        428        27.8%
                 Other                            39         2.5%
                 Unknown Race/Ethnicity           50         3.3%
                 Total                          1,538       100.0%


Healthy New Jersey 2010 sets forth target rates of hospitalization due to asthma by
race/ethnicity per 100,000 population. Newark currently exceeds these targets, as does
New Jersey (Healthy NJ 2010 – Update 2005).

Deaths due to asthma. Twelve (12) Newark residents died from asthma in 2003. The
number for the South Ward is not known. But this is 11% of New Jersey total deaths
due to asthma, which is three times higher than the expected percentage for Newark.
(3% based on population.)
City of Newark - Community Health Assessment
Updated: February 2007                                                                                        Page 19




                                         2004 Newark Resident Hospital Admissions for Asthma -
                                          Estimated Rate per 100,000 and Healthy NJ 2010 Target

                                700
                                                            648.2
                                        2004
                                600                                                           578.6
                                        2010 Target
                                                                              530.9

                                500
  Rate per 100,000 Population




                                400



                                300
                                                                    250.0

                                200
                                        187.4
                                                                                      150.0           150.0
                                                100.0
                                100



                                 0
                                      NonHispanic White   NonHispanic Black    Hispanic          Total




Cancer
The impact of cancer is assessed by morbidity (prevalence of cancer) and mortality
(deaths due to cancer).

Cancer morbidity (prevalence). (From NJDHSS). Prevalence is defined as the
proportion of the population with a disease, i.e., the number of people alive with the
disease divided by the total population, at a point in time. Prevalence is dependent
upon the incidence of and survival from the disease. Cancer prevalence is an important
measure of the burden of cancer in a population and on the health care system. Cancer
prevalence statistics can be used for public health planning, to target health care
resources, and to estimate survivorship.

Data below, from the report, “Cancer Prevalence in New Jersey on January 1, 2003”
(November 2006), contains the first comprehensive presentation of cancer prevalence
estimates for New Jersey based on data from the New Jersey State Cancer Registry
(NJSCR), the population-based cancer incidence registry for New Jersey.
City of Newark - Community Health Assessment
Updated: February 2007                                                         Page 20


Data on prevalence of cancer is available only at the level of Essex County, not Newark.
Comparisons on cancer prevalence in Essex County and New Jersey show that the
prevalence rates are similar.


             Estimated Prevalence and Percents on January 1, 2003 –
                         Essex County and New Jersey
                                         Essex County       New Jersey
             Sex
                Males                         3.4%              3.6%
                Females                       4.0%              4.2%
             Race
                White                         4.9%              4.3%
                Black                         2.4%              2.2%
             Ethnicity
                Hispanic                  Not available     Not available
             Age
                0-39                           NA               0.4%
                40-64                          NA               3.9%
                65+                            NA              18.4%
             Total                            3.7%              3.9%

             By Site
                Female Breast                 1.6%              1.6%
                Cervix Uteri                  0.3%              0.2%
                Colon and Rectum              0.4%              0.4%
                Lung                          0.1%              0.1%
                Melanoma                      0.1%              0.2%
                Oral cavity                   0.1%              0.1%
                Prostate                      1.6%              1.5%
                Urinary Bladder               0.2%              0.2%
             Source: NJDHSS.



Mortality. Cancer is the second leading cause of death in Newark, New Jersey and the
United States. There were 480 deaths due to cancer among Newark residents in 2003.

The percent of deaths due to cancer (all types) is less in Newark than in New Jersey –
at 20% versus 24% in 2003. However, Newark residents die younger from cancer than
New Jersey residents, especially Newark residents under age 65.
City of Newark - Community Health Assessment
Updated: February 2007                                                                                Page 21




                                      Distribution of 2003 Deaths due to Cancer - Newark and NJ

                              35%



                              30%



                              25%
  % of Deaths due to Cancer




                              20%



                              15%



                              10%



                              5%



                              0%
                                    Age 5-14   Age 15-24   Age 25-34   Age 35-44   Age 45-54   Age 55-64   Age 65-74   Age 75-84   Age 85+

                                                                       Newark          New Jersey
City of Newark - Community Health Assessment
Updated: February 2007                                                          Page 22



Prostate Cancer

There were 35 deaths due to prostate cancer among Newark residents males in 2003.
Prostate cancer accounts for fewer than 3% of male deaths, both in Newark and New
Jersey. Prostate cancer does not disproportionately affect all Newark males.

However, over three quarters of Newark deaths due to prostate cancer occurred among
Newark African American males. This is higher than the percent of African American
males among Newark’s total population. So although the total number of deaths is
relatively low, prostate cancer does disproportionately affect Newark’s African American
males.

Newark males die from prostate cancer at earlier ages than the rest of New Jersey.
Timely screening and treatment might prevent this unfortunate trend.
City of Newark - Community Health Assessment
Updated: February 2007                                                                        Page 23




                 Distribution of Male Deaths due to Prostate Cancer by Age in 2003 -
                                           Newark and NJ

        35%



        30%



        25%



        20%



        15%



        10%



            5%



            0%
                 45-49 years   50-54 years   55-59 years   60-64 years   65-69 years   70-74 years   75-79 years   80-84 years   85-89 years
   Newark           0.0%          0.0%          5.7%          0.0%         14.3%          8.6%         22.9%         22.9%         25.7%
   New Jersey       0.3%          0.9%          2.4%          4.0%          7.3%         13.1%         19.2%         22.9%         29.9%
City of Newark - Community Health Assessment
Updated: February 2007                                                         Page 24


Child and Adolescent Health
Much information on behavior of Newark’s children and adolescents has to be gleaned
from statewide data sources and estimated for the city. This is due to confidentiality
restrictions and requirements. However, health problems that present themselves
among youth statewide are certainly experienced by Newark youth and should be part
of a comprehensive approach to community health improvement.

Smoking among Adolescents

The Youth Risk Behavior Survey (YRBS) was conducted by the NJ Dept. of Education
most recently in 2005. This survey questioned adolescents and middle school children
about smoking. Approximately 20% of Newark adolescents age 15-18 said they had
smoked within the past 30 days, as did 5% of Newark children age 12-14


           Adolescents who smoked cigarettes during the past 30 days
                                   Statewide percent      Estimated for Newark
     High school (age 15-18)              20%                     3,300
     Middle school (age 12-14)            5%                       600
                                                                  3,900



Drug Use among Adolescents

Similarly, the YRBS reported substance use among youth statewide in 2005. The
statewide rates were applied to the population of Newark youth by age to estimate the
number who might have used specified substances.
City of Newark - Community Health Assessment
Updated: February 2007                                                          Page 25




                        Substance Use Among Adolescents
                                                 Statewide         Estimated for
                                                  percent             Newark
    One drink of alcohol in past 30 days
       High school (age 15-18)                      46%                 7,500
       Middle school (age 12-14)                     NA                  NA
          Total                                                         7,500
    Tried/Used Marijuana
       High school (age 15-18)                      36%                 5,900
       Middle school (age 12-14)                    7%                   850
          Total                                                         6,750
    Tried/Used Cocaine (any form)
       High school (age 15-18)                       6%                 1,000
       Middle school (age 12-14)                     3%                  360
          Total                                                         1,360
    Tried/Used Inhalants, sprays, glue
       High school (age 15-18)                      10%                 1,600
       Middle school (age 12-14)                    9%                  1,100
          Total                                                         2,700
    Tried/Used steroids
       High school (age 15-18)                       2%                  330
       Middle school (age 12-14)                    1.5%                 180
          Total                                                          510

    High school students only (age 15-18)
      Used heroin                                    2%                  330
      Used methamphetamines                          3%                  500
      Used ecstasy (MDMA)                            5%                  800
    NA = Not asked.



Births to Teenage Mothers

Births to teenage mothers (under age 20) in Newark declined as a percent of total live
births – from 20.4% of births in 1990 to 13.4% in 2004.
City of Newark - Community Health Assessment
Updated: February 2007                                                                                      Page 26


         Newark Resident Births and Births to Teen Mothers from 1990-2004
               Births to Teen          % Total                                  Births to Teen          % Total
  Year            Mothers            Live Births                    Year           Mothers            Live Births
  1990                1,331                 20.8%                   1998               891                  18.8%
  1991                1,294                 20.3%                   1999               847                  17.6%
  1992                1,186                 20.2%                   2000               819                  16.9%
  1993                1,081                 19.2%                   2001               795                  16.3%
  1994                1,140                 20.5%                   2002               672                  14.6%
  1995                1,082                 20.4%                   2003               688                  14.4%
  1996                1,026                 20.2%                   2004               625                  13.4%
  1997                 990                  19.4%




                 Percent of Newark Resident Births to Teenage Mothers
                              (< Age 20) from 1990 - 2004

 25%


       20.8%

 20%




 15%


                                                                                                             13.4%

 10%




  5%




  0%
       1990    1991   1992    1993   1994    1995   1996   1997   1998   1999   2000   2001   2002   2003    2004




Mortality Due to Homicide

There were 77 deaths due to homicide in Newark in 2003. Of these, nine or 12%
occurred among adolescents age 15-19 and eight were among Black/African American
(non-Hispanic) adolescent males.

This computes to an estimated mortality rate of 158.0 deaths per 100,000 African
American (Non Hispanic) males age 15 to 19, which is much higher than the target
mortality rate of 28.2 for this population set forth in Healthy New Jersey 2010.
City of Newark - Community Health Assessment
Updated: February 2007                                                         Page 27



Diabetes
Nearly 7% or 444,000 of New Jersey adults 18+ years have been diagnosed with
diabetes in 2001-2003. It is estimated that an additional 178,000 adults (2.7%) have
diabetes but have not been diagnosed. This is nearly one in 10 (9.5%) adults.

In Newark in 2004, this computes to approximately 13,500 adults age 18 and older with
diabetes and an estimated 5,500 individuals undiagnosed.

People at highest risk of diabetes are: persons over the age of 45, persons who are
obese, and racial/ethnic minorities. Because two of these factors are increasing in
across the US – people are getting older and obesity is increasing – diabetes
prevalence will continue to increase.

In 2003, 128 Newark residents died from diabetes in 2003. They died at younger ages
than the rest of New Jersey. Healthy People 2010 and Healthy New Jersey 2010
benchmarks for diabetes are reduction in deaths due to diabetes. However, there are
many steps that can be taken to reduce diabetes.



              Percent of Total Deaths due to Diabetes, 2003

                5.5%




                                         3.4%
                                                                   3.0%




              Newark                      NJ                       US
City of Newark - Community Health Assessment
Updated: February 2007                                                                                                  Page 28




                                                          Distribution of Deaths due to Diabetes by Age in Newark and New
                                                                                    Jersey - 2003

                                                 35%



                                                 30%
  Percent of Total Deaths due to Diabetes




                                                 25%



                                                 20%



                                                 15%



                                                 10%



                                                     5%



                                                     0%
                                                            Age 15-24   Age 25-34   Age 35-44   Age 45-54   Age 55-64      Age 65-74   Age 75-84   Age 85+
                                            Newark            0.0%        1.6%        5.5%       10.9%       21.9%          23.4%       21.9%      14.8%
                                            New Jersey        0.2%        0.5%        2.0%        8.3%       13.3%          22.1%       30.4%      23.1%
City of Newark - Community Health Assessment
Updated: February 2007                                                          Page 29



Environmental Health

Childhood Lead Poisoning

Newark has a higher than average incidence of childhood lead poisoning compared to
the entire state per most recent blood-lead monitoring data available for 2005. Over
18% or 125 of the state’s 677 cases of Elevated Blood Lead Level (EBL) of 20 g/dL
and 15% (516) of the state’s 3,371 cases of Blood Lead Level (BLL) of 10-19 g/dL
occurred among Newark children under age 6. These rates are four times as high as
the expected rate of 3.7% (25,609), which is the percent of New Jersey’s children under
age 6 residing in Newark, underscoring that Newark children are disproportionately
impacted by lead poisoning.Although the number of children with EBL has declined in
Newark and New Jersey from 1993 to the present, Newark has maintained its pro-rata
share of EBL children.

The highest risk for children is found in houses built before 1950, when paints contained
a very high percentage of lead. There are 44,755 (45%) housing units in Newark built
before 1950 versus 30% in New Jersey and 22% in the U.S. (Census, 2000). Of these
older units, 61% (16,235) in Newark are renter occupied versus one third in New Jersey
and the U.S.
City of Newark - Community Health Assessment
Updated: February 2007                                                          Page 30



Heart Disease and Stroke
Heart disease is the leading cause of death in Newark, New Jersey and the United
States. In 2003, 527 Newark residents died of heart disease, which is 22.5% of total
deaths. Although this is a lower percentage of total deaths than New Jersey or the
United States because the percent of deaths due to other reasons is higher.
Unfortunately, Newark residents die of heart disease at much younger ages than the
rest of New Jersey.

Hypertension/Cardiovascular Disease

Hypertension or high blood pressure is known as the “silent killer” and remains a major
risk factor for coronary heart disease (CHD), stroke, and heart failure. High blood
pressure is more common in older persons.

Over one in four (25.6%) of adults age 18 and older in New Jersey have been
diagnosed with high blood pressure (BRFSS). It is estimated that 29% of Newark adults
have high blood pressure.

Hypertension increases with age. Statewide, over 54% of adults age 65 and older have
been told by a doctor that they have had high blood pressure. For Newark, this means
that targeting the population age 65 and older is critical. Given that many Newark
residents experience heart disease at younger ages (indicated by deaths), all adults age
35 and older should be targeted.

Stroke (Cerebrovascular Disease)

There were 101 deaths due to stroke among Newark residents in 2003. Deaths due to
stroke accounted for 4.3% of deaths in Newark and New Jersey in 2003. However, as
with heart disease, Newark residents died of stroke at much younger ages than
residents throughout the state.
City of Newark - Community Health Assessment
Updated: February 2007                                                                                              Page 31




                                              Distribution of 2003 Deaths due to Heart Disease - Newark
                                                                        and NJ
                                     45%


                                     40%


                                     35%
  % of Deaths due to Heart Disease




                                     30%


                                     25%


                                     20%


                                     15%


                                     10%


                                     5%


                                     0%
                                           < Age 5   Age 5-14   Age 15-24   Age 25-34    Age 35-44    Age 45-54   Age 55-64   Age 65-74   Age 75-84   Age 85+

                                                                                Newark               New Jersey
City of Newark - Community Health Assessment
Updated: February 2007                                                                                              Page 32




                                              Distribution of 2003 Deaths due to Stroke - Newark and NJ

                                     45%


                                     40%


                                     35%
  % of Deaths due to Heart Disease




                                     30%


                                     25%


                                     20%


                                     15%


                                     10%


                                     5%


                                     0%
                                           < Age 5   Age 5-14   Age 15-24   Age 25-34    Age 35-44    Age 45-54   Age 55-64   Age 65-74   Age 75-84   Age 85+

                                                                                Newark               New Jersey
City of Newark - Community Health Assessment
Updated: February 2007                                                             Page 33



HIV/AIDS

HIV/AIDS is a problem in Newark. Over 2% of Newark residents (5,975) are living with
HIV/AIDS as of June 30, 2006. Newark is disproportionately impacted by HIV – with
18% of NJ PLWHA but only 3% of NJ population.

HIV disproportionately affects various populations of Newark residents versus New
Jersey. These include: women, those infected heterosexually, injection drug users (IDU),
Black/African American residents, those age 55 and older, and children under age 13.


                         People Living with HIV/AIDS in Newark
                                                 AS OF JUNE 30, 2006
                                       Number                       Percent
      NEWARK                   Male    Female    Total   Male        Female    Total
      Disease Category                                    58.2%        41.8%   100.0%
      HIV                      1,729     1,335   3,064    50.1%        53.9%    51.7%
      AIDS                     1,159       793   1,952    33.6%        32.0%    32.9%
      AIDS OI                    561       348     909    16.3%        14.1%    15.3%
      Total                    3,449     2,476   5,925   100.0%       100.0%   100.0%
      AIDS Total               1,720     1,141   2,861    49.9%        46.1%    48.3%
      Current Age
      < 13                        29        44      73      0.8%       1.8%      1.2%
      13 – 24                    105        91     196      3.0%       3.7%      3.3%
      25 – 34                    289       334     623      8.4%      13.5%     10.5%
      35 – 44                  1,067       918   1,985     30.9%      37.1%     33.5%
      45 – 54                  1,322       788   2,110     38.3%      31.8%     35.6%
      55+                        637       301     938     18.5%      12.2%     15.8%
      Total                    3,449     2,476   5,925    100.0%     100.0%    100.0%
      Age 45+                  1,959     1,089   3,048     56.8%      44.0%     51.4%
      Race/Ethnicity
      Hispanic                   680       333   1,013     19.7%      13.4%     17.1%
      Black, Not Hispanic      2,609     2,048   4,657     75.6%      82.7%     78.6%
      White, Not Hispanic        138        74     212      4.0%       3.0%      3.6%
      Other/Unknown               22        21      43      0.6%       0.8%      0.7%
      Total                    3,449     2,476   5,925    100.0%     100.0%    100.0%
      Racial/Ethnic Minority   3,289     2,381   5,670     95.4%      96.2%     95.7%
      Transmission Category
      MSM                        600         0     600     17.4%       0.0%     10.1%
      IDU                      1,232       820   2,052     35.7%      33.1%     34.6%
      MSM/IDU                    150         0     150      4.3%       0.0%      2.5%
      Heterosexual             1,059     1,410   2,469     30.7%      56.9%     41.7%
      Not Reported/Other         408       246     654     11.8%       9.9%     11.0%
      Total                    3,449     2,476   5,925    100.0%     100.0%    100.0%
City of Newark - Community Health Assessment
Updated: February 2007                                                    Page 34




          Percent of New Jersey's PLWHA in Newark -
                            6/30/06


      Heterosexual                                    19.2%



                IDU                                       21.6%


                                                          Newark has
               MSM               9.3%                     17.8% of NJ's
                                                          PLWHA


           Hispanic                     14.3%



 Black, Not Hispanic                                               25.3%



            Age 55+                               18.9%



   Children < Age 13                                              24.7%



               Men                            16.1%



            Women                                       20.8%


                       0%   5%   10%    15%       20%           25%        30%
City of Newark - Community Health Assessment
Updated: February 2007                                                                                Page 35




                                                        Distribution of Deaths due to HIV Disease by Age in Newark and New
                                                                                    Jersey - 2003

                                                    45%


                                                    40%
  Percent of Total Deaths due to HIV Disease




                                                    35%


                                                    30%


                                                    25%


                                                    20%


                                                    15%


                                                    10%


                                                        5%


                                                        0%
                                                             5-14   15-24   25-34   35-44   45-54   55-64       65-74   75-84   85 and over
                                               Newark        0.6%    0.6%    7.7%   42.9%   31.4%   12.2%       3.2%    0.6%       0.0%
                                               New Jersey    0.3%    0.9%    6.3%   35.1%   39.6%   12.3%       4.3%    0.9%       0.2%
City of Newark - Community Health Assessment
Updated: February 2007                                                                          Page 36



             People Living with AIDS and HIV - Rates per 100,000 Population - Newark EMA
                                     and NJ (2005) and US (2004)

   2,250

                                                                    EMA's 5 Largest Cities (76% of PLWH)
   2,000


   1,750


   1,500

                                                         EMA's 5 Counties
   1,250


   1,000
                   EMA vs NJ vs US

     750


     500


     250


      0
                                 NJ
           Newark     New                 US                                                   East                                 Plain-    Total 5
                              outside            Essex     Morris   Sussex   Union   Warren          Irvington Newark Elizabeth
            EMA      Jersey             (2004)                                                Orange                                 field    Cities
                              of EMA
    PLWH   608.4      377.2   304.9     247.8    1,181.0    128.2     79.7   457.4   100.6    1,849.2   1,532.0   2,092.2   804.4   1,030.6   1,641.1
City of Newark - Community Health Assessment
Updated: February 2007                                                       Page 37


Infectious Diseases
Tuberculosis

Cases of tuberculosis have been on the decline in Newark, New Jersey and the US.
However the case rate per 100,000 population remains higher in Newark, at 16.8, than
in these two other jurisdictions.



                        Active Tuberculosis 2000-2005 –
                   Cases and Case Rate per 100,000 Population

                           2005       2004      2003      2002       2001      2000
Newark
  Cases                      47        61        58         77        62         65
  Case Rate per 100,000     16.8      21.9      20.9       28.8      23.2       24.3
New Jersey
  Cases                     485       482        495       530       530        565
  Case Rate per 100,000     5.6       5.5        5.7       6.2       6.2        6.7
United States
  Cases                   14,097     14,515    14,840     15,056    15,946    16,309
  Case Rate per 100,000    4.8        4.9        5.1        5.2       5.6      5.8




Childhood Immunizations

Childhood immunization rates are measured or children age 19 to 35 months using the
4:3:1:3 series. 4:3:1:3 encompasses four or more doses of DTP, three or more doses
of poliovirus vaccine, one or more doses of any MCV, and three or more doses of Hib.
Data are available for Newark, New Jersey and the United States. The Newark rates
have increased significantly over the past five years and have reached the highest
levels in many years.
City of Newark - Community Health Assessment
Updated: February 2007                                        Page 38




                   Childhood Immunization Rates for Ages 19-35 months for
                              4:3:1:3 Series - 2000 through 2005

            90%


            80%


            70%


            60%


            50%


            40%


            30%


            20%


            10%


            0%
                      2000       2001      2002       2003              2004    2005
   Newark             63.1%      64.0%     59.9%      74.0%             74.5%   77.3%
   New Jersey         75.9%      76.2%     80.4%      75.8%             83.3%   78.5%
   United States      76.2%      77.2%     77.5%      81.3%             82.5%   82.4%
City of Newark - Community Health Assessment
Updated: February 2007                                                                 Page 39


Maternal and Infant Health
Prenatal Care

Appropriate prenatal care, that is, care provided by a health professional to pregnant
women, can enhance pregnancy outcome by assessing risk, providing health care
advice, and managing chronic and pregnancy-related health conditions.

Women residing in Newark who gave birth in 2004 continued to receive timely prenatal
care (first trimester) at lower rates than their counterparts in the rest of New Jersey and
across the U.S. – at 56.0% versus 75.8% and 83.9%, respectively.

Similarly, the percent of Newark women giving birth in 2004 who had no prenatal care
(4.9%) exceeded the statewide rate (1.2%) and national rate (0.9% estimated).



             Percent of Births in 2004 with Timely Prenatal Care (First
                            Trimester) - Newark, NJ, US

 90%


 80%


 70%


 60%


 50%


 40%
                                                                          83.9%
                                             75.8%
 30%
                 56.0%

 20%


 10%


  0%
                Newark                     New Jersey                  United States
City of Newark - Community Health Assessment
Updated: February 2007                                                                      Page 40


Low Birthweight

The weight of the newborn is an important predictor of future morbidity and mortality.
Low birthweight - less than 2,500 grams (5 lbs. 8 oz.) - carries risks. For very low
birthweight infants - less than 1,500 grams or 3 lbs. 4 oz. - the risk of dying in the first
year of life is nearly 100 times that of normal weight infants. The risk for moderately low
birthweight infants (1,500 to 2,499 grams) is more than five times higher than that of
heavier newborns.

Of the 4,655 Newark resident births in 2004, 11.5% were of low birthweight. This rate is
higher than comparable totals for New Jersey of 8.0% and the United States at 8.1%.
By race/ethnicity, low weight births to African American mothers were higher than the
total rates, at 15.4% of total African American births in Newark, and 13.5% in New
Jersey and the United States.

The percent of very low weight births in 2004 was higher in Newark, at 2.6% of total live
births versus 1.5% for New Jersey and the US.

Infant Mortality

The rate of infant mortality - deaths per 1,000 live births - in Newark is higher than in
New Jersey and the United States – 11.5 versus 5.7 and 6.9 in 2003.

Rates of black infant mortality in 2003 were higher in all geographic areas – at 16.8 in
Newark, 12.0 in New Jersey, and 14.0 in the US.


                              Total and Black Infant Mortality in 2003 - Newark, NJ, US

                        18%
                                 Newark
                        16%      New Jersey
                                 United States
                        14%


                        12%
  % Total Live Births




                        10%


                        8%
                                                                    16.8%
                                                                                    14.0%
                        6%
                                 11.5%                                      12.0%

                        4%
                                                      6.9%
                                              5.7%
                        2%


                        0%

                                              Total                         Black
City of Newark - Community Health Assessment
Updated: February 2007                                                                Page 41




                                    Percent Births of Low Birthweight in 2004 -
                                                Newark, NJ and US

                  18%


                  16%                                 15.4%

                                                            13.7%13.7%
                  14%


                  12%                                                                            11.5%
  % Live Births




                  10%

                                                                            7.8%                         8.0% 8.1%
                  8%     7.4% 7.2% 7.2%                                            7.2%
                                                                                          6.8%

                  6%


                  4%


                  2%


                  0%
                        White Not Hispanic            Black Not Hispanic       Hispanic                  Total

                                             Newark            New Jersey    United States
City of Newark - Community Health Assessment
Updated: February 2007                         Page 42



Mental Health

(Under development.)




Oral Health

(Under development.)
City of Newark - Community Health Assessment
Updated: February 2007                                                                                Page 43



Sexually Transmitted Diseases

Newark has more than its proportionate share of all of New Jersey’s cases of sexually
transmitted diseases (STDs) in 2005. Newark has only 3.3% New Jersey’s total
population but a much higher percentage of STDs.


       Cases of Sexually Transmitted Diseases in 2005 – Newark and New Jersey
                                            Syphilis
                     Primary +        Early       Late and
                     Secondary        Latent    Late Latent          Congenital      Gonorrhea        Chlamydia

Newark                      25            145               67               7            1,300              2,331
New Jersey                134             289              379              14            5,720           19,152
% Newark of NJ
                      18.7%           50.2%              17.7%           50.0%           22.7%            12.2%
  Cases




           Percent of NJ Sexually Transmitted Disease Cases Occurring
                                 in Newark - 2005

 60%

                                                                                    Newark is 3.3% of
                         50.2%                               50.0%
 50%
                                                                                    NJ total population.



 40%




 30%

                                                                                 22.7%

 20%      18.7%                            17.7%

                                                                                                  12.2%
 10%




  0%
         Primary +     Early Latent     Late and Late       Congenital       Gonorrhea           Chlamydia
         Secondary       Syphilis      Latent Syphilis       Syphilis
          Syphilis
City of Newark - Community Health Assessment
Updated: February 2007                                                        Page 44



Mortality - Leading Causes of Death

•   The top 10 leading causes of death for Newark and New Jersey are shown in the
    attached figures. A table compares Newark, New Jersey and the United States for
    2003.

•   The top three causes of death in Newark are #1 Heart Disease, #2 Cancer, and #3
    HIV/AIDS. In contrast, the top three causes of death in New Jersey are #1 Heart
    Disease, #2 Cancer, and #3 Stroke.

•   Deaths due to HIV/AIDS are a significant health issue in Newark versus statewide.
    This is because HIV/AIDS is no longer one of the 10 leading causes of death in New
    Jersey; in fact, it is estimated to rank #13. Newark accounted for 24% of New
    Jersey deaths due to HIV disease, but is only 3% of the state’s population.

•   Similarly, deaths due to homicide rank #9 in Newark but #19 statewide in New
    Jersey. Newark accounts for 19% of New Jersey deaths due to homicide.

•   With respect to race and ethnicity, the top two leading causes of death among all
    populations in Newark are #1 Heart Disease and #2 Cancer. There are differences
    in subsequent rankings.

          o Among Blacks/African American Newark residents, HIV/AIDS is the #3
            leading cause of death. This is followed by #4 Diabetes and #5 Homicide.

          o Among Hispanic/Latino Newark residents, diabetes is the #3 leading
            cause of death. This is followed by #4 Accidents and #5 HIV/AIDS.

          o Among white Newark residents, diabetes is #3 leading cause. This is
            followed by #4 Septicemia and #5 Stroke.
City of Newark - Community Health Assessment
Updated: February 2007                                            Page 45




                              2003 Leading Causes of Death - Newark




                                                                  #1 Heart Disease,
                    Residual, 22.4%                                    22.5%




           #10 Respiratory
            Disease, 2.9%

         #9 Homicide, 3.3%

         #8 Kidney Disease,
                3.3%
                                                                         #2 Cancer, 20.5%
               #7 Stroke, 4.3%


                #6 Septicemia, 4.3%
                     #5 Accidents, 4.4%
                                 #4 Diabetes, 5.5%   #3 HIV/AIDS, 6.6%
City of Newark - Community Health Assessment
Updated: February 2007                                       Page 46




                           2003 Leading Causes of Death - New Jersey



                    Residual, 21.1%
                                                                #1 Heart Disease,
                                                                     29.7%



       #10 Alzheimer's
        Disease, 2.2%
    #9 Kidney Disease,
           2.3%
      #8 Influenza &
     Pneumonia, 2.5%
    #7 Septicemia, 2.6%
         #6 Accidents, 3.1%

              #5 Diabetes, 3.4%
                  #4 Respiratory
                  Disease, 3.9%
                                                        #2 Cancer, 23.9%
                          #3 Stroke, 5.3%
City of Newark - Community Health Assessment
Updated: February 2007                                                               Page 47




                     Top 10 Leading Causes of Death in 2003 – Newark, NJ, US

     Newark                                  New Jersey*                                 United States**


#1   Heart Disease           527   22.5%     Heart Disease            21,801   29.7%     Heart Disease      685,089    28.0%
#2   Cancer                  480   20.5%     Cancer                   17,551   23.9%     Cancer             556,902    22.7%
#3   HIV                     156    6.6%     Stroke                    3,914    5.3%     Stroke             157,689    6.4%
#4   Diabetes                128    5.5%     Chronic Lower             2,890    3.9%     Chronic Lower      126,382    5.2%
                                             Respiratory                                 Respiratory
                                             Disease                                     Disease
#5   Accidents               105    4.5%     Diabetes                  2,470    3.4%     Accidents          109,277    4.5%
#6   Septicemia              102    4.3%     Accidents                 2,285    3.1%     Diabetes            74,219    3.0%
#7   Stroke                  101    4.3%     Septicemia                1,887    2.6%     Flu/Pneumonia       65,163    2.7%
#8   Kidney Disease           78    3.3%     Flu/Pneumonia             1,802    2.5%     Alzheimer's         63,457    2.6%
#9   Homicide                 77    3.3%     Kidney Disease            1,680    2.3%     Kidney Disease      42,453    1.7%
#10 Chronic Lower             68    2.9%     Alzheimer's               1,626    2.2%     Septicemia          34,069    1.4%
    Respiratory
    Disease
     Total Deaths          2,346             Total Deaths             73,410             Total Deaths      2,448,288

      * HIV disease is not ranked in NJ and at 656 deaths accounts for only 0.9% of total NJ deaths.
      ** HIV disease is not ranked in US and at 13,658 deaths accounts for only 0.6% of total US deaths.
City of Newark - Community Health Assessment
Updated: February 2007                                  Page 48



             10 LEADING CAUSES OF DEATH IN NEWARK (2003)
                        – BY RACE & ETHNICITY

       Black/                      Hispanic/
       African American            Latino                    White

#1     Heart Disease      21.8%    Heart Disease    19.5%    Heart Disease    28.4%

#2     Cancer             20.6%    Cancer           18.2%    Cancer           21.7%

#3     HIV/AIDS           8.5%     Diabetes         8.3%     Septicemia       6.1%

#4     Diabetes           4.9%     Accidents        6.6%     Diabetes         5.6%

#5     Homicide           4.6%     HIV/AIDS         5.3%     Stroke           5.4%

#6     Accidents          4.3%     Kidney Disease   4.0%     Respiratory      5.4%
                                                             Disease
#7     Septicemia         4.3%     Stroke           3.6%     Accidents        3.2%

#8     Stroke             4.1%     Liver Disease    3.6%     Kidney Disease   2.9%

#9     Kidney Disease     3.4%     Flu/Pneumonia    2.6%     Flu/Pneumonia    2.5%

#10    Respiratory        2.2%     Respiratory      2.6%     Hypertension     1.8%
       Disease                     Disease
City of Newark - Community Health Assessment
Updated: February 2007                                                              Page 49




                       EMERGENCY PLAN
The City of Newark maintains a comprehensive emergency preparedness plan under its
Office of Emergency Management (OEM). The City of Newark has also established a
Department of Homeland Security which coordinates emergency planning and
response. Newark participates planning for chemical, biological, radiological/nuclear
and explosive (CBRNE) events and public health emergencies.

Under the city’s Emergency Operations Plan, the Newark Department of Health and
Human Services (DHHS) is responsible for planning and is the lead agency for
response to public health emergencies. In its emergency planning and response,
Newark has two parallel and coordinated structures and chain of command under the
Incident Management System (IMS) for overall emergency planning and public health
emergencies. This is shown below.


     Chain of Command in Newark for Emergency Operations and Public Health
                                 Emergencies


         Emergency Operations                      Public Health Emergencies
                                                 (bioterrorism, prophylaxis, treatment)



       N. J. State Office of Emergency           N. J. State Office of Emergency
                 Management                                Management



           Essex County Office of
          Emergency Management



        Newark Office of Emergency                   Newark Dept. of Health &
               Management                               Human Services
                                                        (Health Officer)




Metropolitan Medical Response System. In 2000, the City of Newark was designated
by the federal government as a Metropolitan Medical Response System (MMRS) city,
and, with federal funding, is responsible for leading and coordinating response to
medical and public health emergencies in the greater Newark area. The geographical
region covered by MMRS funding is the Greater Newark Area in Essex County, New
City of Newark - Community Health Assessment
Updated: February 2007                                                           Page 50


Jersey, which includes Newark and surrounding municipalities in which the county’s 10
acute care hospitals are located (five in Newark and five in the rest in Essex County).
Newark ranks #14 among Urban Area Security Initiative (UASI) jurisdictions.

Newark has most recently forged an alliance with Newark Liberty International Airport,
U.S. Public Health Service’s Quarantine Division and the Port Authority of New York
and New Jersey (PANY/NJ). Staff from these agencies work closely on quarantine plan
development, communicable disease detection and investigation protocols if detected in
passengers arriving or departing on international flights at Newark Airport. In 2006,
Newark expanded its MMRS Operational Area to include the City of Elizabeth and
Trinitas Hospital in Elizabeth, Union County. This has enabled MMRS to provide
enhanced public health response to hazardous events occurring at Newark Airport,
which is partially located in Elizabeth.

MMRS planning is conducted through a Steering Committee and subcommittees. The
Newark Health Officer has statutory responsibility for public health in Newark, and has
been designated by the DHHS Director as the Chairperson of the MMRS Steering
Committee. The Newark MMRS management team is led by the Steering Committee,
which meets six times per year. Completion of planning milestones and related
activities is accomplished by five MMRS subcommittees through regular meetings:
Hospital, Pharmaceutical, Decontamination, Surveillance, and Emergency Management
Services (EMS). This structure has operated successfully since MMRS inception. A
minimum of 55 stakeholders are represented on the committees.

Public health emergency planning. Newark DHHS is one of 22 LINCS agency and
participates in ongoing emergency planning in coordination with and under the direction
of NJDHSS.

Newark DHHS and the City participate in regional and state TOPOFF emergency
response exercises with the State, Essex County and Newark OEM.

Most recently in November 2006, Newark DHHS was one of 22 LINCS agencies and
local public health departments to receive grants from the CDC through NJDHSS to
increase the state’s ability to prepare for and respond to a potential influenza pandemic.
The purposes of the grants were to (1) conduct assessments and analyses of their
current pandemic influenza preparedness capabilities (phase 1) and (2) to develop,
exercise and improve local and regional operational plans for pandemic influenza and to
continue to address priorities previously identified in their phase-one assessment.
(NJDHSS, 2006.)

In January 2006, DHHS (Newark Homeless Health Care Program) was one of 14
Federally Qualified Health Centers (FQHC) to receive a grant from NJDHSS to enhance
their capabilities to respond to chemical, biological, radiological, nuclear and explosive
incidents. (NJDHSS, 2006.)
City of Newark - Community Health Assessment
Updated: February 2007                                                                     Page 51




                                REFERENCES
Census Bureau. 2005 American Community Survey.

Census Bureau. Current Population Survey: Annual Demographic File, 2002-6. 2006. Data
      provided by N.J. Department of Health and Senior Services. Estimates based on
      weighted data.

Census Bureau. Population Estimates. 2005.

Centers for Disease Control and Prevention. Asthma and Allergies.
       http://www.cdc.gov/health/asthma.htm. Accessed January 2007.

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance Survey
       (BRFSS). http://www.cdc.gov/vbrfss/about.htm. Accessed January 2007.

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance Survey
       (BRFSS). Prevalence Data. New Jersey – 2005 Exercise. Accessed January 2007.
       http://apps.nccd.cdc.gov/brfss/display.asp?cat=EX&yr=2005&qkey=4347&state=NJ

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance Survey
       (BRFSS). SMART: Selected Metropolitan/Micropolitan Area Risk Trends. 2005 -
       Newark-Union, NJ-PA Metropolitan Division. Health Risk Data –Exercise. Accessed
       January 2007. http://apps.nccd.cdc.gov/brfss-smart/
       MMSARiskChart.asp?yr=2005&MMSA=58&cat=EX&qkey=4347&grp=0

Centers for Disease Control and Prevention. National Immunization Program. National
       Immumzatin Survey – Immunization Coverage in the US. Accessed December 2006.
       http://www.cdc.gov/nip/default.htm

Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2005.
       Atlanta, GA: U.S. Department of Health and Human Services, CDC, September 2006.

Current Population Survey: Annual Demographic File, 2002-6. 2006. Data provided by N.J.
       Department of Health and Senior Services. Estimates based on weighted data.

Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2004. National Vital Statistics
       Reports; vol 55 no 1. Hyattsville, MD: National Center for Health Statistics. 2006.

New Jersey Department of Education. Report on the 2005 New Jersey Student Health Survey
      of Middle and High School Students. Youth Risk Behavioral Survey. Trenton, NJ.
      August 2006. http://www.state.nj.us/njded/students/yrbs

New Jersey Department of Human Services. Division of Addiction Services. Information
      Systems Management. Trenton, NJ. June 2006. New Jersey Drug and Alcohol Abuse
      Treatment - Substance Abuse Overview 2005 – Essex County.
      http://www.state.nj.us/humanservices/das/Chartbooks/Sub_Abuse_%20Overview%2020
      05/ESS2005.pdf
City of Newark - Community Health Assessment
Updated: February 2007                                                              Page 52




New Jersey Department of Health and Senior Services. Office of the Commissioner. NJDHSS
      awards nearly $6.5 Million to local heath agencies for pandemic influenza preparedness.
      November 16, 2006. Trenton, NJ. http://www.state.nj.us/cgi-
      bin/dhss/njnewsline/view_article.pl?id=2992

New Jersey Department of Health and Senior Services. Office of the Commissioner. NJDHSS
      Awards $5 Million in Grants to New Jersey Health Care Facilities to Enhance Emergency
      Preparedness Capabilities. January 24, 2006. Trenton, NJ. http://www.state.nj.us/cgi-
      bin/dhss/njnewsline/view_article.pl?id=2895

New Jersey Department of Health and Senior Services. Cancer Epidemiology Services. Public
      Health Services Branch. Cancer Prevalence in New Jersey on January 1, 2003.
      Trenton, NJ. November 2006.
      http://www.state.nj.us/health/ces/documents/prevalence_report.pdf

New Jersey Department of Health and Senior Services. Center for Health Statistics. Healthy
      New Jersey 2010 - A Health Agenda for the First Decade of the New Millennium. Vol 1
      and Vol 2. Trenton, NJ. 2000. http://www.state.nj.us/health/chs.

New Jersey Department of Health and Senior Services. Center for Health Statistics. Healthy
      New Jersey 2010 – Update 2005. Trenton, NJ. May 2005.
      http://www.state.nj.us/health/chs/hnj.htm.

New Jersey Department of Health and Senior Services. Communicable Disease Service.
      Sexually Transmitted Diseases Statistics and Tuberculosis Morbidity. 2005.
      http://www.state.nj.us/health/cd/std/stdstats/stdstats2005.pdf.
      http://www.state.nj.us/health/cd/documents/tbstats.pdf

N.J. Department of Health and Senior Services. Division of Family Health Services. Childhood
       Lead Poisoning in New Jersey - Annual Report Fiscal Year 2005 (July 1, 2004 to June
       30, 2005). Trenton, NJ. 2006.

New Jersey Department of Health and Senior Services. Health Care Quality and Oversight.
      Health Care for the Uninsured Program. New Jersey Hospital Care Payment Assistance
      Fact Sheet. January 2006. http://www.state.nj.us/health/cc/documents/ccfactsh.pdf

New Jersey Department of Health and Senior Services. Health Care Quality and Oversight.
      Health Care for the Uninsured Program. SFY 2007 Hospital Charity Care Distribution
      Amounts. Accessed January 2007.
      http://www.state.nj.us/health/cc/documents/sfy2007ccs.pdf

New Jersey Department of Health and Senior Services. Health Care Quality and Oversight.
      Hospital Financial Reporting and Support. UB-92 Patient Discharge Data File – New
      Jersey 2004. Trenton, NJ. 2000. http://www.state.nj.us/health/chs.

U.S. Department of Health and Human Services. Healthy People 2010. Chapter 24 –
       Respiratory Diseases. Washington, DC.

U.S. Department of Labor. Bureau of Labor Statistics. Unemployment rates 2005.
City of Newark - Community Health Assessment
Updated: February 2007                                    Page 53




       MOBILIZING FOR ACTION
        THROUGH PLANNING &
        PARTNERSHIP (M.A.P.P.)
        COALITION PARTNERS
                 &
  Staffing, Facilitation & Technical Assistance
                   provided by:
                                                   Well-
  Maria E. Vizcarrondo, Director of Child & Family Well-Being

      Rawaa Albilal, Director of Strategic Planning, Resource
                 Development
                 Development & Social Services

                Marsha McGowan, Health Officer

      Deborah Edwards, Assistant Director, Personal Health
                           Services

  Nikeysha Harris, Public Health Practice Standards Partnership
            Coordinator & M.A.P.P. Coordinator

				
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