City Of Newark Summary Community Themes and Strengths Assessment

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					        City Of Newark

Community Themes and Strengths

          Newark Department of
        Health and Human Services
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                                                                        Page i

                                                      Newark Health Plan

                  Summary: Community Themes and Strengths Assessment

                                                        Table of Contents

List of Abbreviations ..................................................................................................................... iii


Quantitative Study ...........................................................................................................................1
       Methods ...............................................................................................................................1
       Findings of the Quantitative Analysis .................................................................................3
               Section 1: Socio-Demographic Characteristics .......................................................3
               Section 2: Health Insurance Coverage.....................................................................4
               Section 3: Health Status...........................................................................................7
               Section 4: Usual Source of Care ..............................................................................8
               Special Population: Newark’s Youths and Young Adults.....................................12

Qualitative Study – Part 1 Key Informant Interviews ..................................................................18
       The Changing Face of the Population Served ...................................................................19
       Populations’ Services Needs and the Changing Landscape ..............................................22
       Selected Effects of Environmental Challenges and the Changing Landscape On
       Area Providers ...................................................................................................................24
       Community-Centered Issues..............................................................................................25
       Gaps in Service Delivery ...................................................................................................35
       Summary of the Community’s Need for Selected Special Services..................................41

Qualitative Study – Part 2 Focus Group Discussions ...................................................................43
       Focus Group Discussions with Various Groups of City of Newark Residents .................43
       Methods .............................................................................................................................43
               Sources of Data......................................................................................................43
       Focus Group Findings: Results of the Focus Group Discussions......................................46
               Background: The Changing Face of the Newark Neighborhood ..........................47
               Socio-Demographic Characteristics ......................................................................48
               Status Report on the City.......................................................................................48
               Community Concerns ............................................................................................48
       Other Concerns ..................................................................................................................55
               Causes of Community Decay ................................................................................58
       Community Strengths ........................................................................................................61
               Health Effects of Environmental Conditions.........................................................63
               Perception of Health and Common Health Problems............................................64
               Common Health Problems.....................................................................................65
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                                                                  Page ii

                 Knowledge of Health Problems and Concerns ......................................................67
                 Lifestyle Changes ..................................................................................................67
          Access to Care ...................................................................................................................68
                 Source of Health Care............................................................................................68
          Barriers to Care..................................................................................................................70
          Barriers to Care by Ward and Population..........................................................................70
                 Use of Health Department .....................................................................................79
          Community Need...............................................................................................................79
          Suggestions for the Health Plan.........................................................................................81

Community Forums .......................................................................................................................83
     Results of the Community Forum Evaluation ...................................................................83
            Socio-demographics. .............................................................................................83
     Community Health Issues..................................................................................................86
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                    Page iii

                                   List of Abbreviations

BRFSS        Behavioral Risk Factor Surveillance System
CDC          U.S. Centers for Disease Control and Prevention
DHHS         Newark Department of Health and Human Services
DYFS         Division of Youth and Family Services (child welfare agency; now within the N.J.
             Department of Children and Families)
ER           Emergency Room or Emergency Department of a hospital
FQHC         Federally Qualified Health Center
HIV+         HIV positive
HOPWA        Housing Opportunities for Persons With AIDS
HPV          Human Papillomavirus
IDU          Injection Drug User
LHD          Local Health Department
MAPP         Mobilizing for Action through Planning and Partnerships
MSM          Men who have Sex with Men
NJPAC        New Jersey Performing Arts Center
NHHC         Newark Homeless Health Care of the Newark DHHS
OSHA         Occupational Safety and Health Administration (U.S.)
PLWHA        People Living with HIV/AIDS
STD          Sexually Transmitted Disease
UMDNJ        University of Medicine and Dentistry of New Jersey
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 1


Note: This information is a summary of documents dated December 20, 2006 prepared for the
Newark Department of Health and Human Services. Two research approaches - quantitative and
qualitative - were utilized for this assessment project. Select data from the full report are
presented in this summary. The percents have been rounded to the nearest whole number for
reader ease. The reader should refer to the full report for the most accurate percentage figures.

The Community Themes and Strengths Assessment is one of four assessments required to be
conducted by local health departments (LHDs) as part of the MAPP process. MAPP stands for
Mobilizing for Action through Planning and Partnerships. The four assessments are: (1)
community health assessment, (2) community themes and strengths assessment, (3) forces of
change assessment, and (4) local public health system assessment.

The Community Themes and Strengths Assessment is a vital part of a community health
improvement process. During this phase, community thoughts, opinions, and concerns are
gathered, providing insight into the issues of importance to the community. Feedback about
quality of life in the community and community assets is also gathered. This information leads
to a portrait of the community as seen through the eyes of its residents. Mobilizing and engaging
the community, when successful, it ensures greater sustainability and enthusiasm for the process.

The information in this assessment was the result of numerous meetings and countless hours of
devoted work by staff of the Newark Department of Health and Human Services (DHHS), the
partnership agencies, community residents, and community-based organizations who contributed
individuals for the study. Several meetings and conversations were held to inform the various
key stakeholders about the Community Themes and Strengths Assessment and to gain their
support for the project. Members of the Newark Planning Partnership provided input to the
planning process, served on committees, provided access to their specific clientele or target
populations, and helped guide the research activities. The study was designed to garner broad
support from the relevant community groups and key stakeholders, whose contributions would
also be needed later in the implementation stage, when recommendations may be executed.

                                    Quantitative Study


Target population and participation. Inclusion criteria were (1) residence in the specific ward
being studied, (2) age 18 or older, (3) and expressed interest in sharing with the research staff
their specific concerns and insights about the issues being investigated. Survey respondents were
recruited through various groups including community-based agencies, public schools, day care
centers, churches, barber shops, community development corporations, public housing projects,
youth programs, recreational programs, elderly homes, and drug treatment facilities.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 2

A five person team from the Newark DHHS set up sites for the study by contacting local pastors,
community leaders, and providers of targeted services such as those serving substance abusers,
the elderly, specific immigrant populations, and other key informants. Only persons who were
readily accessible through the various venues participated, e.g., only youth at program sites at the
time participants were selected provided responses. However, special effort was made to reach
hard-to-reach groups. Incentive packets containing $25 were provided to survey respondents and
$100 to each agency for use of their facility and staff. A 100% response rate was received to the
survey questionnaires which were completed on-site prior to the focus group sessions.

Survey instrument. A survey instrument was used consisting of several structured and some
open-ended questions which provided clarification on some of the structured responses. Two
survey instruments were developed: adult and youth surveys. The adult survey consisted of 32
questions designed to capture data on the community’s health profile, with additional questions
on a wide range of health-related issues. The youth survey consisted of 51 questions which
investigated a wide range of issues of relevance to this population group. Several open-ended
questions were in the youth questionnaire to capture qualitative data on mental health which is
said to impact their overall well-being and lifestyle. The survey questionnaires were approved
by key staff from the Newark DHHS. Informed consent was obtained from all respondents.

The sample consisted of 167 adults and 43 youths. The average age of the survey respondents
was 44, with a range from 18 to 90. More than half of the respondents were older than age 50.
The average length of residency in the city was five years. Most respondents were women. The
surveys were administered by trained research personnel using structured questionnaires.

Procedures. The survey was a self-administered questionnaire with the ability to ask questions
if needed, which encouraged individuals to answer sensitive questions to which they would
otherwise not respond. This approach maintained confidentiality and sensitivity toward
participants. Nonetheless, specific populations, such as the elderly, non-English speaking
immigrants and those with an educational level below eighth grade, were provided assistance
when requested by trained interviewers (DHHS staff) accompanying the research team.

All survey items were read verbatim in a face-to-face format. For those needing translation
assistance, such as Creole, Spanish and Portuguese-speaking respondents, the information was
translated and back-translated by staffers who spoke these languages. Consent forms were also
read verbatim for respondents, questions were answered, and consent was obtained prior to
administration of the questionnaires. For example, one DHHS staff member who spoke
Portuguese translated the questionnaire into Portuguese, then research staff and host-agency staff
who also spoke Portuguese back-translated into English to ensure consistency of data and
minimize discrepancies. This was also the case among our Hispanic respondents who needed
translation assistance. Hence, discrepancies in these cases were reconciled by additional staff.

The amount of time spent on completing the survey varied based on educational attainment, age,
primary language spoken, health status and attention span, but ranged from 10 to 25 minutes.
Pre-testing of the instrument lasted two weeks in June 2006. Interviews and administration of
the survey was conducted over a five-month period from June through October 2006.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 3

Measures included the following. Socio-demographic variables: Participants’ age, gender,
education, marital status, employment status, length of residence in Newark, area of residence
(as indicated by ZIP codes), household size, and self-defined primary language spoken at home.
Health status/perceived health: A numerical five-point scale with 1 to 5 indicating “excellent” to
“poor” health, the presence of and type of a physician-diagnosed health condition(s). Health-
seeking behavior: Use of preventive health services, the type of services sought, timing of
screenings (within the last 12 months or more than 12 months), point of entry into care, health
care utilization behavior, number of hospitalizations, use of emergency room (ER) services,
reasons for ER visit or the hospital stay, number of clinic or doctor visits within the last 12
months, and mental health related to anxiety or depression. Access to health care: Health
insurance status, difficulties getting prescriptions, regular source and location of health care,
access to a private physician, difficulties getting needed care, transportation to care, and waiting
time for care once contact is made. Youth-specific issues: Mental health status, health care
behavior, and violence (perceived and actual), social ties. Reliability and validity of youth
questionnaire items have been established from state surveys on adolescents.

Analysis. Data were analyzed by wards following a general assessment for all Newark residents.
Data on seeking health services and access to adequate health care were computed for the whole
sample and within sub-populations. Frequency statistics and descriptive statistics were used to
determine the relationship between the study variables. Differences in focus groups (by ward or
demographic variables) were compared using cross-tabulations. No effort was made to control
for the effect of any of the variables. It was not necessary to use more extensive statistical
methods such as multivariate logistic regression. Focus groups, which provided a rich source of
descriptive data, were used to explain some of the study’s quantitative findings.

Findings of the Quantitative Analysis

Section 1: Socio-Demographic Characteristics

Frequencies. A total of 316 Newark residents completed the community survey, but not every
person answered every question. Percentages are therefore indicated.

Most respondents lived in ZIP                      Respondents by ZIP Code of Residence
code 07108, followed by 07106              07102      5%     07105     13%      07108         20%
and 07103 – with the lowest                07103     15%     07106     19%      07112          3%
percent from 07112.                        07104      7%     07107      9%      07114          9%

Length of time in Newark. Of the 241 (76%) who reported length of residence in Newark, one
third lived in Newark 10 or more years, 19% from 6 to 10 years, 37% from one to five years, and
10% under one year.

Gender. More females (60%) responded than males (40%). Age. Of the 299 who reported age,
19% were age 65 or older, one third were age 40-64 (16% age 40-49 and 17% age 50-64), 14%
were age 30-39, 28% were age 20-29 and only 6% were age 18-19.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 4

Race/Ethnicity. Nearly all residents (312) answered this question, with two-thirds African
American, 18% Hispanic/Latino, those of Caribbean ancestry at 6%, whites at 5%, Africans at
4% and Asians and mixed race at less than 1% each. Language spoken at home. Although more
than three-quarters (78%) of respondents spoke English as a primary language at home, all
respondents of Hispanic origin also indicated Spanish as the primary language at home.

Marital status. A preponderance of respondents identified themselves as single (61%), widowed
(11%) or divorced/separated (8%), with the remaining 20% indicating they were married.

Education level. A majority of respondents had a high school diploma/GED (42%), some
college (16%) or a college degree or more (12%), with the remaining respondents having less
than a high school education (30%).

Employment. All respondents answered this                    Respondents’ Employment Status
question showing an array of employment            Employed        32%     Unemployed     68%
and unemployment situations.                       Full time        17%    Unemployed     20%
                                                   Part time        14%    Student        16%
Additional descriptive statistics or cross-        Military         1%     Disabled       14%
                                                                           Retired        18%
tabulations in the full report show more
detail about the above characteristics – race/ethnicity, age, gender, educational attainment and
employment status by ZIP code, which is important for targeting health initiatives and resources.

Section 2: Health Insurance Coverage

Frequency Statistics. A total of 313 Newark residents provided responses to the question “Do
you have health insurance?” Slightly more than two-thirds (69%) reported they had insurance,
29% did not, and 2% did not know. Half of the respondents had dental insurance, while 46% did
not, and 4% did not know. The latter two groups were collapsed together to form the uninsured.
Approximately one third reported that they went without medications, particularly those in ZIP
codes 07107 (44%) and 07103 (46%). Respondents ages 40-49 (49%) and ages 18-19 (39%)
also reported inability to afford required drugs. More males than females reported not getting the
medications they need because of an inability to pay for them (40% vs. 28%).

Health Insurance Coverage and Type. Respondents were asked if their insurance covered
medications. Of the 170 (79%) insured respondents who answered this question, 84% (143)
noted their insurance covered medications, while the remaining 16% (27) did not have
medication coverage (13%) or did not know (3%).
                                                                    Insurance Types          %
A total of 100 (29%) indicated they had on occasion gone         Commercial                 20%
without medication because of an inability to pay (could         Blue Cross Blue Shield     13%
not afford them). A total of 152 (62%) respondents               Medicare                   20%
indicated some form of health insurance, of which 5% had         HMO                        12%
either Charity Care or Family Care, and 1% had Social            Medicaid                   22%
Security (Medicare). Among the truly insured (143),              Medicare/Medicaid          13%
distribution is indicated in the table to the right.             Total                     100%
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                            Page 5

By ZIP code, the highest percent of uninsured respondents resided in ZIP code areas 07102 and
07105, followed closely by those in ZIP areas 07103 and 07104.

A higher percentage of female                 Uninsured Respondents by ZIP Code of Residence
respondents (74%) than males              07102    50%      07105     50%      07108     23%
(60%) had health insurance                07103    41%      07106     23%      07112     22%
coverage.                                 07104    41%      07107     32%      07114     11%

With respect to age, lack of health insurance is more pronounced at 41% among those ages 25-
29. By race/ethnicity of respondents, Africans (100%), African Americans (73%), and whites
(69%) were more likely to have health insurance than Hispanics (55%) and Caribbean (60%).
By education attainment, high school graduates were least likely to have health insurance.

While nearly two-thirds of the employed respondents had health insurance, 71% of unemployed
respondents had insurance – mostly from Medicaid, Medicare, or other government program.

Summary of Findings. According to existing research, one significant measure of the access
problem is the proportion of people without health care coverage. The argument exists that lack
of health insurance is the strongest determinant of access to care, creating obstacles to health care
access at both individual and system levels.

This study found a modest proportion of uninsured respondents (29%). This would indicate that
the majority of respondents had access to care, given the established relationship between health
insurance and access to care. However, findings further suggest that the majority of the insured
were covered by Medicaid and/or Medicare. Informal discussions with area providers revealed
that Medicaid-insured patients are less likely to receive adequate, timely and appropriate care;
more likely to receive care through public clinics or hospital outpatient clinics; and more likely
to have multiple health problems. This means that these individuals are likely to require
effective medication management to effectively deal with their health problems. Yet many lack
access to such resources, or lack coverage for medications (13%). More importantly, nearly one-
third of respondents indicated they had gone without medication because they could not afford it.

Descriptive analysis showed that the ZIP code areas with the highest proportion of uninsured
respondents had several specific characteristics that increased such prevalence. These factors
included a substantial proportion of the unemployed; less than a high school education; single
(not married), and/or a large population of youth, Hispanics and/or whites (mainly Portuguese).

Consistent with state findings of the New Jersey Behavioral Risk Factor Surveillance System
(BRFSS), more females (74%) than males (60%) were insured, and married respondents are
more likely to be insured than any other group (except the widowed mainly elderly). However,
insured percentages in Newark are lower than statewide (females at 87.7% and males at 83.2%)
and the gap between genders was wider. Likewise, although respondents age 65 and over (88%)
were more likely to have health insurance than any other group, the Newark rate was also lower
than the statewide BRFSS (97.7% in 2005). Combined, 72.9% of all blacks in the study had
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 6

health insurance, which was higher than Hispanic (55%) and white (69%) respondents, but rates
are lower compared with statewide BRFSS figures (2005) at blacks (86.1%) and whites (92.8%).

The uninsured in the study are nearly four times more likely than the insured to go without
medication due to cost - 19% of insured respondents and 64% of the uninsured reportedly had
gone without medication because of cost. The problem of going without medications was
reported most frequently in zip codes 07107 (44%) and 07013 (47%). Respondents ages 40-49
(49%) and ages 18-19 (39%) frequently reported inability to afford required drugs, as did males
versus females. Employment status was a factor in difficulty accessing needed medication, with
the unemployed (34%) more than the employed (28%) reporting this problem.

Discussion. Experts have noted that factors causing disparity in care are complex, varied and
not well understood. They include socioeconomic status, insurance coverage, availability of
services (geographical distribution of consumer and providers), and health status. Although
more than two-thirds (69%) of the study population in Newark are insured, when compared to
the state figure (85.5%) from the New Jersey 2005 BRFSS, the percentage of respondents is
relatively low. Site-specific data exists to indicate that a substantial proportion (about 40%) of
patients using local public health facilities, including the Newark DHHS and/or the Federally
Qualified Health Center (FQHC), are uninsured or receive charity care in area hospitals.

Research has shown, however, having health insurance does not equal access. Getting in the door
of a doctor’s office does not necessarily equal receiving needed services and may have nothing
to do with the intensity or the quality of the services provided. Data from key informant
interviews and focus groups (discussed below) revealed that not only are there fewer area
providers that accept Medicaid insurance, but area residents in need of more specialized services
may have to go outside of the community for their health care. While insured respondents are
more likely to have access to a specialist than their uninsured counterparts, being Medicaid-
insured minimizes these chances.

The majority of respondents reported that meeting basic everyday needs of food, child care and
housing takes precedence over their health care needs. Since the potential negative consequences
of noncompliance with a medication schedule are not often immediate, there is a false sense of
security as patients think they can postpone filling their prescriptions. While there are resources
in the community to assist with prescriptions (e.g., Newark Homeless Health Care (NHHC), a
program of Newark DHHS), these services are often available only to special populations such
as the homeless, many of whom are still unaware of their availability.

The respondents also included a substantial immigrant population, many of whom have cash-
based employment that is not reported as income. Many work in part-time jobs and do not
qualify for Medicaid because they lack the necessary documentation to show proof of income, a
requirement for Medicaid enrollment. Many also lack the language skills to navigate the health
and social services systems, both sources of relevant resources for vulnerable populations.
Among the majority of this population, health care is not a priority because seeking treatment
may reveal their status as illegal aliens. For many, emergency rooms, outpatient clinics,
community-based clinics, and local health departments are considered regular sources of care.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 7

Section 3: Health Status

This section examined issues associated with the health status of the study population: their
perception of their health, the presence of physician-diagnosed illnesses, and pain and disabilities
they experienced. The attempt was to understand the extent of the population’s health needs,
identify possible solutions to some of the issues that exacerbate their health problems, and create
a basis for measuring and adjusting to changes in any of the health indicators.

With respect to health status, there were five response categories,       Health Status        %
ranging from excellent to poor. The fourth and fifth categories          Excellent              9%
(i.e., fair and poor) were collapsed to form one response category       Very Good             16%
(fair/poor). Of the total of 313 respondents to this question, 9%        Good                  39%
considered themselves in excellent health, 26% felt their health         Fair/Poor             36%
was very good, over one-third (39%) reported good health, and            Total                100%
the remaining 36% considered their health to be fair/poor.

With respect to area of residence, respondents in zip code 07105 were least likely to report
themselves to be in excellent health while zip codes 07106 (58%), 07112 (56%) and zip code
07114 (56%) were most likely to report fair/poor health status.

By gender, a relatively equal percent of males (26%) and females (25%) considered themselves
to be in excellent or very good health. A relatively similar percent of females (37%) and males
(34%) considered their health to be fair/poor.

When race/ethnicity was considered, African American respondents were slightly less likely than
their other black counterparts to consider their health excellent or very good. As shown below,
Hispanics more than any other racial groups in the study considered their health to be good. And
Caribbean Islanders (45%) and whites (37.5%) viewed themselves to be of fair/poor health more
than respondents of other races (29%).

    Perceived Health                                  Race/Ethnicity
          Status             African                    Caribbean
                                             African                      Hispanic        White
         (N=306)            American                     Islander
  Excellent Health            20 (10%)        1 (8%)        4 (20%)         3 (6%)        1 (6%)
  Very Good Health            33 (16%)        3 (25%)       3 (15%)         9 (16%)       2 (13%)
  Good Health                 78 (38%)        4 (33%)       4 (20%)        26 (47%)       7 (44%)
  Fair/Poor Health            72 (36%)        4 (33%)       9 (45%)        17 (31%)       6 (37%)

Perceived health status was directly related to level of education. Of those who viewed their
health to be excellent or very good, the highest percent of respondents had at least a college
education (33%) versus those with less than a high school education (20%). The corresponding
figures for those with high school diplomas and those with some college education were 27%
and 29%, respectively. Respondents with less than a high school education more frequently
reported fair/poor health (42%) than those in any other educational category. Likewise, the
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 8

employed are more likely to consider their health excellent or very good (40% vs. 19%). More
unemployed respondents (44%) than employed (17%) considered their health to be fair/poor.

Data on health status was examined to determine the perception of health status, illnesses, pain,
and disabilities experienced by survey respondents. One third reported having a problem related
to a chronic health condition, while 5% said they did not know. The remaining 63% did not have
a chronic health problem. However, respondents appeared to lack understanding of what is a
“chronic” health problem. When asked if they had been told by a physician that they had any
health complications considered chronic (diabetes, hypertension, asthma, HIV/AIDS, heart
disease, stroke, tuberculosis, obesity and/or cancer), many respondents answered affirmatively.
Study data showed that a sizeable proportion had more than one health problem, and that 17%
had three or more known health complications.

Perception of excellent, very good, or good health was inversely correlated to a medical visit.
That is, the percent of those who did not have a medical visit reported better health. Of those
reporting fair/poor health, over one-third (36%) had a health visit but one-quarter (27%) did not
report any health visits.

The importance of not knowing if a health problem is chronic cannot be overestimated. If the
population with any of these diseases does not consider them a chronic health problem, then it
would be difficult to get them to manage these conditions effectively. This lack of understanding
of their health conditions could translate to delayed access to timely and appropriate care.

A total of 179 (95%) of those with diagnosed chronic health problems provided specific health
diagnoses. Of these, 78 (44%) had hypertension, 57 (32%) had asthma, 38 (21%) had diabetes,
30 (17%) had heart disease, 15 (8%) had cancer, 18 (10%) had obesity, and 19 (11%) had other
health complications (e.g., sexually transmitted diseases, HIV/AIDS, arthritis, and hepatitis).
These figures overlap because many respondents had more than one health complication. The
full report shows descriptive statistics, comparing the nature of respondents’ health problems
with a series of demographic variables.

Section 4: Usual Source of Care

This section examined selected health care behaviors of respondents to better identify the issues
that impact their health and appropriate interventions to meet their health care needs. Use of
health care services was examined in terms of source of care, visits to the clinics or private
physician offices, use of preventive health services, use to emergency room services, and
hospital admissions.

Frequencies. A total of 309 (nearly 100%) respondents answered the question on whether they
had a source of regular care – 77% (238) had a regular source of care and 23% (71) did not. A
sizeable proportion (41% or 97) of those with a source of care considered school-based clinics,
hospital emergency rooms and hospital outpatient clinics their medical home.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 9

Hospitals of choice for these               Regular Source of Health Care                   %
respondents (90) were mainly the            Hospital                                       35%
University of Medicine and Dentistry        Emergency Rooms Only                            3%
of New Jersey (52%), Newark Beth            Newark Community Health Center (FQHC)          11%
Israel Medical Center (17%), Saint          Private Physician                              41%
Michael’s Medical Center (10%), St.         School-Based Clinic                             3%
James Hospital (6%), and Veterans           No Source Provided                              7%
Hospital (6%), and other hospitals          Total                                         100%
(11%) including East Orange General,
Clara Mass and Columbus hospitals.

Health Care Utilization - Emergency Room Use. Of a total of 302 (96%) responding to the
question of emergency room (ER) use, more than one-third (39%) had used the hospital ER in
the past 12 months. ER use is a factor of the lack of a regular source of care. Respondents using
hospitals and the FQHC as a regular health care source more frequently reported ER visits. Half
(53%) reported one ER visit, 21% had two visits, and 26% had three or more visits. Females
used the ER (41%) slightly more than males (36%) with more multiple visits (49% versus 45%).
Respondents age 40-49 (50%) frequently reported use of emergency room services. Use of ER
services declined with increasing level of education. Hispanic respondents (55%) were more
likely to make multiple emergency room visits, followed by African Americans (47%). Insured
respondents (39%) were slightly more likely than the uninsured (37%) to use ER services, and
were also more likely to report multiple visits than the uninsured (49% vs. 36%, respectively).

A total of 67 (21%) respondents who used the ER reported being hospitalized in the last 12
months, and slightly more than half (55%) made two or more visits. Nearly half (49%) were age
50 or older. An equal proportion (20%) of African Americans and Hispanics were hospitalized.
Respondents who reported ER visits were nearly four times more likely to have been
hospitalized (40%) than those who did not (11%).

Evident in this pattern of ER use is the fact that respondents would make multiple visits if their
illness had not been taken care of, or they might go home and return another day if they did not
receive needed care in earlier visits. Often, these individuals would wait hours at a time to be
seen, leave and return another day with a more severe health problem requiring hospitalization.

Medical visits. Most (94%) of those who used health care services within the last 12 months
answered the question “In the last 12 months, how many times did you go to a doctor’s office or
clinic to get health care for yourself?” Of these, 17% had one visit, 20% two visits, with the
remaining 63% reporting three or more visits.

Transportation to medical care. Means of transportation to care has been found to impact
access to care. Data revealed that 29% of respondents drove to care, 11% got rides from others,
28% took the bus, while 9% walked to care. Another 8% took other means of transportation,
including ambulance, van services and trains, and the remainder (14%) took a combination of
modes including driving, bus, ambulance services, and walking. By gender, more males (38%)
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 10

than females (23%) drove to care. The percent of males and females taking a bus to care was the
same (28% vs. 27%, respectively). However, a bus ride to care was the most frequently reported
means of transportation among females versus private transportation among males.

By race/ethnicity, bus ride was the most common method among African Americans (31%).
Caribbean Islanders mostly drove to care (67%), Hispanics either drove to care (29%) or took a
bus (29%). Those using a variety of transportation mechanisms were mainly African Americans
(60%) or Hispanics (31%). By education level, those with less than a high school education
were likely to take a bus (39%) or drive to care (15%). Among high school graduates and all
other educational groups, preferred modes were private transportation (27%) or bus ride (22%).
It is relevant to note that bus ride was the second most frequently cited means of transportation
among those accessing the health care system, surpassed only by private transportation. By
employment status, the majority of employed respondents (57%) drove to care versus the
unemployed who most frequently reported means of transportation to be a bus ride (32%).

Difficulty Accessing Care. A total of 310 respondents (98%) provided responses to the
question whether they had difficulty getting care in general. Slightly more than one-third
reportedly had difficulty getting the care they needed, while the remaining two-thirds did not.
The main reasons for the difficulties experienced by respondents accessing care included not
having health insurance coverage (65%), transportation problems (18%), inability to get an
appointment (7%), lack of telephone (10%), language barrier (8%), too expensive (19%) and
other reason (9%). Respondents cited multiple reasons in some cases, hence the figures overlap.

Source of care was directly related to respondents’ reported difficulty in accessing health care.
While 14% of those with private physicians had difficulty accessing care, 47% of those seeking
care in any hospital setting and half of those with no source of care reported difficulty accessing
health care. Only a small proportion (29%) of respondents seeking care from school health
clinics indicated difficulty accessing care. Use of hospital clinics or ERs as a source of care, and
not having a health care provider, increased the difficulty of accessing health care. Slightly more
respondents (42%) who had difficulty accessing health care used emergency rooms within the
last 12 months versus respondents who had no difficulties accessing health care (37%).

Males (42%) were more likely to report difficulty accessing care than females (29%). Married
(42%) and single (36%) respondents were more likely to report difficulty accessing health care
than those who were widowed (11%). By race/ethnicity, difficulty accessing health care was
most pronounced among Hispanic respondents (60%) than any other racial group. ZIP codes
07105 (61%) and 07102 (43%) reported the highest proportion of respondents who indicated
they had difficulty accessing health care. Unemployed respondents (34%) reported access
problems more frequently than the employed (29%).

Waiting Time for Care. One portion of respondents (41%) spent 30 minutes or less waiting for
their physician, and another sizeable population spent more than two hours waiting for care after
arrival at the health facility. By type of medical provider, only 3% of those who used the
hospital setting for their care waited 30 minutes or less, versus 48% of patients visiting the
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 11

FQHC and 51% of patients seeing private physicians. Most (44%) hospital users indicated wait
time of two hours or more, as did 28% of FQHC users and 23% of private provider patients.

Use of Emergency Rooms and Hospitals and Perceived Health Status. Perceived health
status did not vary much between respondents who used the ER in the past 12 months and those
who did not. Those who reported a hospital stay reported poorer perceived health status than
those who did not have a hospital stay within the previous year.

                                  Reported Emergency           Reported Hospital Stay
         Perceived Health                                               (312)
                                 Department Visits (298)
                                 Yes (112)   No (186)          Yes (66)       No (246)
       Excellent Health             10%            10%           8%            10%
       Very Good Health             12%            18%           9%            18%
       Good Health                  38%            40%           30%           41%
       Fair/Poor Health             40%            32%           53%           31%

Access to Care: Preventive Health Services. Access to preventive health services is an
important determinant of access to health care and health outcomes. Of the 305 (97%)
respondents answering the question about annual physical exams, the majority (66%) noted
having had at least one preventive health check-up within the last 12 months versus 34% who
had not done so. Of these, 17% had had a prevention screening within the last two years, while a
small but noticeable proportion (7%) never had any type of preventive health screenings. Of the
201 respondents who had a preventive health screening in the last 12 months, 80% provided data
on the services they received. Of these, 10% had only one screening, 14% had two, 12% had
three, 25% had four, and the remaining 40% had five or more preventive screenings.

Preventive health services reviewed in the survey included mammography, Pap smear, flu shots,
prostate screening, blood pressure screening, blood sugar screening, skin examination, eye
examination, and cholesterol checks.

   •   81% (152) of females responded to the question of Pap smear and mammography
       services. Less than half (44%) had had a mammogram, while slightly more than half
       (54%) reported having had a Pap smear exam.
   •   77% (94) of males responded to the question of prostate screening. Less than one quarter
       21 (22%) were screened for prostate cancer as part of their annual physical.
   •   One in six (16%) of all respondents also had colonoscopy examinations as part of their
       preventive health screening for colon cancer.
   •   Of the 250 respondents who provided information about the type of health screenings
       they had, a total of 66% were screened for high blood pressure, 39% were screened for
       diabetes alone, while 35% had a combination of high blood pressure and diabetic
       screenings. One quarter of respondents had flu shots, while one-third were screened for
       cholesterol. Nearly half (44%) had had an eye examination as part of their preventive
       screening but only 4% had had a skin examination. Skin examinations check for skin
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 12

       cancer or melanoma, and are part of the state’s effort to reduce late entry into care for
       those with these health problems.

Difficulty accessing health care may help account for the distribution of use of prevention
services among respondents. The data revealed that respondents who reported any difficulty
accessing health care were far less likely to have had a preventive health visit within the last 12
moths than those who did not report any difficulty (53% vs. 73%). It is noteworthy to repeat that
access to prevention services is a marker for access to health care.

Sources of Regular Care and Preventive Health Care. Having a regular source of health care
impacts the use of preventive health services. Data showed that 69% of respondents who used
the hospital (clinic or emergency room) as their regular source of care had a preventive health
screening within the last 12 months, compared to 81% of those with a private physician as their
regular health care provider, a difference of 12 percentage points. The difference is far more
pronounced between those without any type of health care access points and those with private
physicians (44% vs. 81%). It is encouraging that respondents who used community clinics were
also likely to have had a preventive health care screening during the last 12 months (77%).

Furthermore, respondents who had reported difficulty accessing health care services in general
were less likely to have had the preventive services examined in this study. All services were
impacted - particularly eye exams, diabetes check, blood pressure check, prostate screening,
colonoscopy screening and cholesterol check. The differences are more pronounced for prostate
screening, colonoscopy examination, mammography and blood pressure screenings. For
example, only 27% of those who reported difficulty accessing care had a mammogram versus
48% who did not experience any difficulty. Likewise, only 43% of those reporting difficulty
accessing health care had had their blood pressure checked, versus 79% of those who did not.

Respondents who did not have an annual examination within the last 12 months (44%) were
more likely to view their health as fair/poor versus those who had annual physicals (31%).

There are more data in the full report which elaborate on access to care, preventive services and
diagnosed health problems by age, race/ethnicity, zip code, and years of residence in Newark.

Special Population: Newark’s Youths and Young Adults

A total of 64 youths, ages 17-24 were asked to complete a questionnaire that contained some
youth-specific questions, to gauge their responses on a series of social behaviors and community-
focused issues that were thought to impact their lives. These issues included drug use, age at
which they first had sex, condom use, violence, community resources, and other concerns noted
by key informants as relevant for understanding youth-sensitive issues in the City of Newark.

Demographic Characteristics. Slightly more than half were females (56%) and 44% were
male. Approximately 86% (54) were African Americans, 6% (4) were Hispanic, and the
remaining 8% (5) were white. By age, 14 (22%) were age 17, 36 (57%) were ages 19-20, and
the remaining 13 (21%) were 20-24 years old. By ZIP code of residence, the majority of the 61
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 13

youths who answered this question were from ZIP codes 07103 (46% or 28), 07105 (13% or 8),
07108 (13% or 8), and 07106 (16% or 9). The remaining eight respondents were drawn from
ZIP codes 07102 (3%), 07107 (5%) and 07112 (5%). With respect to education, one-third had
less than a high school education, 48% had a high school diploma, and the remaining 19% had
some college education. Most (72%) were still living at home, while the remaining 28% lived
elsewhere, including rooming with friends and family members. Slightly more than one-third
(36% or 23) were employed and the remaining 64% (41) were unemployed. Three-quarters
(74%) of the employed youths were age 24 and under. There was no difference in employment
status between females and males at 36%.

A series of questions were posed about their social environment and behaviors. Topics included
injuries, weapon use, violence, drug use, sex, and smoking behaviors. Data on violence
examined the number of times during the past 12 months that someone had threatened or injured
them with a weapon (e.g., knife, guns or club) in their neighborhood; that they had been involved
in a physical fight in which they were injured and had to be treated by a doctor; or whether they
simply felt the need to carry a weapon for self defense as a result of their experience in a fight.

Social Problems. In terms of threats of injury with a weapon, three-quarters (46) indicated they
had not experienced any threats or injuries related to weapon use, while the remaining one-
quarter (15) had. Of this latter group, 33% reported one occurrence, 27% reported two, another
27% reported three to five, while the remaining 13% indicated 10 or more occurrences.

Regarding involvement in physical fights, 59% (38) reported no involvement in a physical fight,
and the remaining 41% (26) said they had been in a fight. Of these 26 youths, 35% reported they
had been involved in a physical fight on only one occasion, 27% reported twice, another 27%
included three occasions, while the remaining 12% noted more than four or more occasions. One
respondent noted he had been in more than 30 physical fights during the previous 12 months.

Further, 62 (98%) of the respondents answered the question on the need for weapon use for self
defense in the last 30 days. Among these youths, 15% (9) answered affirmatively, while the
remaining 85% reported they did not feel the need to carry a weapon for self defense as a result
of their experience in a fight. Respondents were asked how many times someone threatened or
injured them with a weapon such as gun, knife, or club, in the past 30 days. Among respondents
age 17, 43% reported experiencing such a threat or injury, as did 15% of those ages 18-19, and
31% of those ages 20-24. State data on violence among high school students show that 11% had
carried a weapon such as a gun, knife, or club in the previous 30 days. The results of our study
revealed that slightly more youths (15%) felt the need to carry a weapon for self-defense.
Female youths (14%) and males (15%) were equally likely to feel the need to carry a weapon as
a result of their experience in a fight. State data show lower rates for females (2%) and males
(8%) carrying weapons to school. Far more young people in our study were likely to carry a
weapon than were reported for the state. In fact, while 25% of our study population reported
having experienced a threat of injury with a weapon, the figure for the state was 8% (BRFSS
2004). In addition, while 41% of our sample reported that they had been in a physical fight, the
comparable figure for the state was 30%. The data would indicate that youth in Newark are
exposed to more violent situations than youths statewide.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 14

Living Arrangement. Of the 64 youths, nearly three-quarters (72%) reported they were still
living at home with at least one parent, one-quarter indicated they were not, while the remaining
3% reported their parents were deceased. When asked “Who is living with you/who takes care
of you?”, the data showed that slightly more than half (52%) reported at least one parent, while
one-quarter indicated either a grandparent (11%) or other relatives that included siblings, aunts
and uncles (14%). A sizeable proportion (27% or 17) either lived alone (17%) or with friends
(9%). Among 73% of the youths, at least a family member provided guardianship. Of the 33
youths who reported parental care, 73% (24) reported a mother was living with them and taking
care of them, 6% (2) indicated a father, and 21% (7) lived with both parents. A total of 52 (81%)
of the youths also responded to the question “Does any parent living outside of the home share
any parental responsibilities?” The data showed that 36 (69%) reported contact with a parent
who lived outside of the household. Of these, however, less than half (47% or 17) indicated that
the parent living outside the household shared parental responsibilities.

Smoking Behavior. Sixty two (98%) youths also answered a series of questions pertaining to
drug use and other social behaviors. On the question “Have you ever smoked cigarettes daily,
that is, at least one cigarette everyday for 30 days?” the results showed that 38% reportedly
smoked, while 62% did not. By gender, half of all the males were smokers versus slightly more
than one-quarter of the females. Many of the youth smokers (71% or 17) reported an attempt to
quit smoking during the past 12 months, equally male and female. By age, 36% of those age 17
reportedly smoked, as did 32% of those ages 18-19, and 625% of those ages 20-24. Among
these youths, 14 of those who attempted to quit were either age 17 (43%) or ages 18-19 (57%).
In the past 30 days, 38% of youths reportedly smoked every day. This figure was six times
higher than the state figure for high school students who smoked every day (6%). (BRFSS 2003).
Females (28%) were less likely to report they smoked daily than males (50%), but these figures
exceed statewide data for females (22%) and are more than double that reported for males (20%).

Drinking Behavior. An examination of alcohol consumption behavior showed that 29 youths
(45%) reported drinking alcohol at least once during the past 30 days. Among those who
reported drinking, 15 (54%) responded to the question about the number of days during the
previous month (i.e., 30 days) on which they had five or more alcoholic drinks in a row. Of
these 15 youth, 47% (7) reported one to two days of five or more drinks in a row, 20% (2) noted
three to five days, and the remaining one third (5) indicated six or more days. In terms of the
number of days in which alcohol was actually consumed during that time, 14% (4) reported they
did not know. Of the 25 who reported number of days of alcohol consumption, slightly more
than one-third (36% or 9) reported one to two days, 28% (7) indicated three to four days, while
12% (3) noted five to eight days of drinking. It is relevant to note that the remaining 24% (6)
reported nine or more days, and among these youths are two who reported 20 or more days.

By gender, females were far less likely to drink than males (12% vs. 39%). By age, alcohol
consumption was highest among those ages 20-24 (54% or 7), followed by those age 17 (21%).
Those in the age group 18-19 (14%) were least likely to report drinking behavior.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 15

Comparing data for the study to the state shows similarities. Regarding alcohol consumption,
45% of youths in our study consumed alcohol at least once during the previous 30 days which is
equal to that reported for high school students statewide (45%). Regarding binge drinking or
having five or more drinks on the same occasion, 24% of all respondents reported such behavior
which is equal to the percentage of students who reported binge drinking statewide (24%).

Illicit Drug Use. A total of 63 youths (97%) responded to the question of illicit drug use. Of
these youths, 19% (12) indicated using drugs at least once in their lifetimes. Ten of these youths
(83%) provided data on frequency of lifetime use. One in five (20% or 2) did not know how
many times they had used drugs, 30% (3) indicated one to five times, and the remaining 50% (5)
noted 50-150 times. The ZIP code containing youths with the most reported drug use behavior
was 07103 (75%), with the remaining 25% in zip codes 07107 (8%), 07108 (8%), 07112 (8%).
By age, 46% (5) of reported users were age 17, and an equal proportion (27%) were ages 18-19
and 20-24. This represented 36% of those age 17, 10% of those ages 18-19, and 25% of those
ages 20-24. Females (13%) were far less likely to report drug use than males (30%).

Sexual Behavior. The youths were asked about their sexual behavior including age at which
they’d first had sex, number of sexual partners within the last three months, and condom and
substance use during intercourse. Age of first sexual intercourse ranged from six to 21. Of the
52 (87%) youths who have had sexual intercourse in their lifetime, 12% (6) were age 0-12, while
50% (26) were age 13-15. This latter group included 42% (11) who reported having their first
sexual experience at age 13. Among the remaining 20 youths, 70% (14) reported that their first
sexual encounter occurred at ages 16-17, and the remaining 30% (6) noted ages 18-21. Of the
eight youths who reported no sexual encounters, five (63%) were girls and three (38%) were
boys. Approximately 13% of girls reported having had their first sexual intercourse by age 12,
compared to 9% of boys. Male youths (62%) were far more likely than females (42%) to report
first sexual intercourse at ages 13-15. On the other hand, female respondents (32%) more than
males (19%) reported first sexual intercourse occurring at ages 16-17, while slightly more
females (13%) reported first sexual intercourse at ages 18-20 than boys (10%).

Regarding the number of sexual partners in the last three months, eight (13%) of the 64 youths
had any sexual encounter, while another six (9%) did not respond to the question. Among the
remaining 50 youths who reported sexual encounters, 68% (34) indicated one partner, 12% (6)
noted two partners, 10% (5) reported three to four partners, and the remaining 12% (6) had five
or more partners. The latter group included three youths who had at least 21 sexual partners. By
age, 82% (9) of those age 17 had one partner, as did 63% of those ages 18-19, and 64% of those
ages 20-24. By gender, while nearly nine in ten females (89%) reported having one partner, the
corresponding figure for male youths in the study was five in 10 (45%).

One in four (22%) of our respondents had had sex with three or more partners in the previous
three months, which is more than twice that reported for the state (9%) (BRFSS 2004). Data
from our study showed more respondents of all ages having three or more sexual partners than
statewide. By age, however, our figure (18%) is equal to that for the state (17%) for those age
17, and at 21% is lower than that reported for the state for the age group 18 and over (35%).
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 16

Among those who reported having sex in their lifetime, 19% indicated they used drugs or alcohol
prior to their last sexual encounter. This figure is the same as that reported for the state (20%).
Male youths (32%) were more likely than female youths (9%) to have used drugs or alcohol
prior. The figure for males statewide (25%) was lower than in our study, but was higher for
females statewide (15%) than reported in our study. Those in the younger age group – 17 years
(21%) – were more likely than older respondents - age 18 and over (16%) - to indicate their last
sexual encounter occurred after drinking or using drugs. The figure for our study was also
higher than that reported for the state for the 16- and 17-year-olds (18%), while the state’s figure
for those age 18 and over (26%) was higher than that reported in our study.

Condom Use. The youths were also asked “The last time you had sexual intercourse, did you or
your partner use a condom?” Eight (13%) indicated they had never had sex. Among the 55
(87%) who had, 45 (82%) reported that they had used condom, while the remaining 10 (18%)
had not. Of the 55 youths who reported sexual intercourse in the prior 30 days, 82% (28) of
those with one partner reported condom use, as did 83% (5) of those with two partners, 80% (4)
of those with three or four partners, and 50% of those with five or more partners. Condom use
decreases somewhat with the increase in the number of partners. The difference was far more
pronounced among those reporting five or more partners versus one partner.

Those age 17 (83%) and 20 to 24 (85%) were more likely to report condom use than those 18
and 19 years old (77%). More males than females reported condom use the last time they had
sexual intercourse (96% vs. 81%).

Eight out of 10 respondents having sex in their lifetime reported that they or their partner had
used a condom the last time they had sex (82%). This figure exceeds that reported statewide
(61%). Statewide figures reported for those ages 16-17 (60%) and those 18 and over (57%) are
far below those reported in our study for the same age groups (83% and 79% for the 16-17
group, and 18 and over group, respectively). It is unclear if respondents are using condoms at
all, or even applying them correctly. However, the youths are aware of their vulnerability to the
sexually transmitted diseases (STDs) that now plague many of their peers, and this knowledge
may have propelled some into action. It was not uncommon for these youths and their parents to
indicate that the young people were passing each other all types of diseases, with one gender
blaming the spread on the other. The fact that these young people are using condoms (self-
report) or even attempting to do so, suggests an added need for targeted distribution of condoms,
accompanied by health and sex education, and perhaps mentoring.

Mental Health. Data showed that almost one in four (23%) youths in our study indicated they
were anxious or depressed. Female youths (25%) were slightly more likely than males (21%) to
report being anxious or depressed. By age, 46% of respondents age 17 reported they were
anxious/depressed, compared to 61% of those ages 18-19, and 46% of those ages 20-24. The
indication is that anxiety or depression was more frequently reported among those ages 18-19
than in any other age group. Further, 15% of those who reported anxiety/depression among the
18 to 19-year olds said they were severely anxious/depressed. No other group indicated a similar
level of anxiety/depression. The state’s BRFSS 2003 study reported that 28% of high school
students indicated signs of depression in the prior year, with girls (35%) more than boys (22%)
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 17

reporting signs of depression. Based on this data, it can be seen that fewer youths in our study
than in the state indicated signs of depression (23% vs. 28%).

Community. Youths were also asked about the resources they have in their various
communities. Of the responses offered, the most frequently cited were recreational programs
(59%), churches (58%), training programs (19%), and social services (14%). Other resources,
including jobs, were noted by 13% of the youths. It is important to note that resource categories
were not mutually exclusive, and hence the figures overlap. The majority of these resources
were reported by youths in zip codes 07103.

The youths were asked which facilities would improve their specific communities. The most
cited facilities were good housing (35%), police facilities - indicating police presence - (20%)
and youth facilities (18%). The availability of these facilities differed across neighborhoods.
For example, the majority (84% or 27) of those who indicated good housing as a needed facility
in their communities were from zip codes 07103 (56%), 07108 (19%), 07106 (9%). Police
presence was reported mainly by those in zip codes 07103 (39%), 07105 (17%), 07106 (17%)
and 07108 (17%). Zip codes 07103 (31%) and 07105 (20%) also reported increased need for
youth facilities to improve the community. The availability of shopping facilities to improve the
community was reported equally (22%) by youths in zip codes 07103, 07105, and 07016.

The youth in the study population were also asked “What are the two things that worry you
most?” A total of 55 (86%) youths provided responses to this question. The responses offered
ranged from worries about gang violence and death (31% or 17) to health (24% or 13) to life in
the community (20% or 11) to school concerns (19% or 10) to unemployment (16 or 9) to lack of
money (11 or 6). A small but noticeable group was concerned about their future and whether
they will be able to have a career (9% or 5) and fear of going to jail (9% or 5). Other concerns
were cited by 13% (7) and these included the fear of losing a family member -- namely a
grandparent -- and being alone (7% or 4), lack of housing (4% or 2), and inability to meet their
children’s needs (2% or 1).
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                             Page 18

                                  Qualitative Study – Part 1
                                  Key Informant Interviews

The qualitative design involved both face-to-face informal interviews with key informants and
focus group sessions with area residents in an effort to ascertain a comprehensive view of the
health and health care issues impacting Newark residents. Details of the focus groups are
explained in Qualitative Study Part 2.


Interviewee Characteristics. A total of 41 individuals were interviewed, drawn from various
organizations and institutions across the city including hospitals, neighborhood-based clinics,
homeless shelters, homeless health care providers, youth programs, community-based
organizations, training programs, and an advocacy and public policy program. Interviewees
included physicians (from various specialties, including cardiology, emergency medicine,
cancer, HIV/AIDS, psychiatry, gynecology, renal disease), mental health counselors, physical
therapists and other rehabilitative staff, social workers, outreach workers, clinic registration staff,
barbers, program directors, advocates, policy analysts and others with information about the
community or the specific group of Newark residents they serve. Interviewees had at least a
high school diploma and worked and/or lived in Newark. It was not uncommon for interviewees
to report employment histories or residence in the city that spanned 30 years or more. By
race/ethnicity, there were 15 Caucasians, 10 Hispanics, two Caribbean Islanders, and 27 African
Americans. They were 16 males and 25 females.

Providers. Various population groups are served by the agencies whose members contributed to
this component of the report. Their contributions served as a guide for the development of the
proposed health plan, and a springboard from which the city can begin to develop some possible
solutions for problems identified in this study. Agencies whose members were included in the
study offer housing, health care, social services, educational services, advocacy services, mental
health services, shelter, substance abuse treatment, and much more. Those with housing services
served the homeless, teenagers, the poor, and families and individuals with HIV/AIDS. Health
care providers serve the general population of health care consumers, and offered extensive
information about the hard-to-reach and vulnerable population groups who are a substantial
proportion of their patient base. Representatives from advocacy programs serve school-aged
children and their families, and community-based providers deliver services to a broader client
base in response to the city’s changing population base and their emerging needs.

All providers offer a comprehensive array of supportive services to more effectively assist the
vulnerable populations served. For example, health care providers increasingly are providing
patients with housing and food pantry referrals in addition to medical care. Agencies offering
housing are now offering parenting skills training, medical appointments, school advocacy,
enrollment in health insurance plans, and navigators to assist clients in negotiating for a range of
services to meet their needs. Advocacy programs help parents develop partnerships to bridge the
increasing cultural gap arising from increased immigration and the resulting changing population
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 19

base. One agency is working to help build organizational capacity and strengthen collaborative
relationships with other providers to minimize the effect of dwindling financial resources.

Another agency offers services to Latino families statewide, with a concentrated effort targeted
to families residing in Newark. Services include outreach to parents, focus on the developmental
milestone (0-5), physical disability, hearing impairment, and emotional needs of children. The
agency services six schools in Newark, and has a medical clinic at a local school to increase
access to primary health. “Problem” children are identified by age six to avoid labeling and
placement of children in special education classes. This agency provides more than the usual
array of services to parents, as part of a larger effort to stabilize vulnerable families.

Another community-based organization providing housing to single homeless adults and teenage
women and their children for over 22 years, is now conducting parenting skills training to
improve family preservation; school advocacy assistance to reduce school absenteeism; and
housekeeping skills to enable families to learn to perform the more routine, everyday functions.
Another agency offers permanent housing for people living with HIV/AIDS (PLWHA), plus a
wide array of supportive services to minimize the impact of HIV on their families and children.

Populations Served. Populations served by providers include the larger population of Newark
residents, special needs children, homeless individuals and families, women with HIV/AIDS and
their children, youths, low-income persons, substance abusers, persons with mental health
problems and/or co-occurring conditions, and other vulnerable population groups. The majority
have low literacy levels, are unemployed, are poor, lack strong informal social support ties, lack
health insurance, are undocumented, have language problems, have chronic health problems, and
are homeless or are at risk of homelessness. The preponderance of these groups in the city helps
to account for the prevalence of poor health outcomes and negative social conditions.

Informants offered insights regarding individuals of all age groups, incomes and races/ethnicity,
but with special emphasis on the population with the greatest needs. A slight majority of those
served are women. Mostly, populations served by these organizations mirror the population of
Newark, with a majority racial/ethnic minorities. Emerging social and health issues faced by the
city’s population must be considered as the city moves to develop its health plan.

Selected Population Profile: Special Needs Children. This population includes children of
women with HIV/AIDS, boarder babies, teenagers who have lost a parent to HIV/AIDS or who
may be aging-out of the child welfare (DYFS) system without an adequate support system and
other vulnerable youth. These populations have a wide range of problems requiring focused
attention from providers, health care institutions, academic institutions and policy makers.

The Changing Face of the Population Served

Increasing among the population served are youths, women, Hispanics, African Americans, and
severely ill individuals. The nature of the social problems that now confront the city has given
rise to a new group of clientele. Issues including crime, HIV/AIDS, unemployment, substance
abuse, community re-entrants (those released from incarceration), the undocumented, a large
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 20

immigrant population, and poverty and its attendant problems, means that area providers must
adjust their services to better address the needs of these emerging populations.

The HIV/AIDS Population. HIV/AIDS has occupied our national landscape for more than two
decades, but the “face” of HIV/AIDS is now an urban one, since the majority of those with the
disease reside in urban communities such a Newark. HIV-infected individuals are now the less
educated, minorities, poor, young, urban dwellers residing in areas plagued by violence, gangs,
and drug use and sales. The HIV/AIDS population in Newark is inconsistent with the national
HIV+ population, largely men who have sex with men (MSM). While the MSM community has
learned how to protect its members, Newark’s at-risk populations of youth, substance abusers,
and women whose partners are injection drug users (IDUs), are yet to develop similar skills. The
pool of the infected in Newark has grown, as has the population of poor and socially challenged
persons. The majority of HIV-infected persons in Newark - IDUs and heterosexual females –
have contracted the disease from sexual relationships with IDUs or PLWHA and have continued
to expose their partners and other members of the [drug] community to the disease.

A new trend is that many of those with HIV in Newark are getting older, the result of effective
drug therapies that now prolong life. One informant noted that “My oldest HIV/AIDS patient is
80 years old.” However, health problems that are common among older adults in the general
population are now being reported by PLWHA, such as diabetes, blood pressure, obesity, heart
disease, cervical and other cancers, and other chronic problems resulting from a compromised
immune system. The uninfected elderly are increasingly at risk for HIV from unprotected sex
with infected partners (“street workers” and IDUs) and due to increased high-risk behaviors.
Older adults may they think they are too old to get the disease or are unaware of their partners’
sexual and/or drug use histories. They may engage in high-risk behaviors due to declining
financial resources, isolation (loneliness and depression), and loss of loved ones. Services and
resources must now be redirected to meet the needs of these emerging HIV-infected populations,
who are no longer only MSMs and IDUs.

The Chronically Ill and Other Health Problems. Health care providers are seeing a younger
population of area residents with chronic health problems. Emergency room and other specialty
care staffers have observed an increase in the number of African Americans who are diagnosed
with severe cases of AIDS, hypertension, diabetes, cardiovascular diseases, stroke, and renal
diseases. Hypertension and diabetes are precursors of health problems that include heart disease,
stroke and renal diseases. While this problem is rampant across the country among African
Americans, the issue confronting Newark is the age at which its residents are presenting with
these health problems. Those at risk of heart disease are in their 40s and 50s, while those with
impaired pump functions (contractual or relaxing) across the country are generally in the 60-and-
older age group. While these experts were unsure as to the effect of hypertension on the rate of
occurrence of cardiac health problems among Newark’s residents, they attribute some of the
causes to poor nutritional health in childhood.

Also of concern to key informants is gender distribution of cardiac problems – at 60%/40% for
Newark males and females, respectively, versus 75%/25% male to female distribution
nationwide. Not only are African Americans with heart conditions in Newark at least eight years
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 21

younger than their counterparts with the same condition nationally, but more women in Newark
than across the country are developing cardiovascular diseases. This may help account for the
lower life expectancy rate for Newark residents than both the state and national rates.

Some agencies observed the relocation of Hispanics from the South to the North Ward, where
many Latino-based programs are located. Many are losing their homes to housing contractors,
and are finding easy access to a wide range of services in the North Ward. This has enormous
implications for area resources in both service capacity and relations among various populations.
E.g., “there used to be more Puerto Ricans and blacks, these two groups get along and
understand each other. However, you now have Mexicans and others from South and Central
America, and you have the race issue coming up between them and African Americans.”

This translates to a surge in a patient population that normally would not have presented at health
care facilities. One health care provider is seeing new groups of Hispanics and working poor
families who in the past sought care from private health care providers. The cost of care has
increased tremendously among this population who are unable to meet the rising cost of office
visits. Many are presenting with severe health problems, more than their previous counterparts,
and are not motivated to attempt early entry into care because they cannot afford the cost. A
sizeable portion of these disconnected individuals include many undocumented persons who
have been in the U.S. for more than 10 years but never able to obtain legal residence.

Another area provider gave further insight into the health status of this population and the larger
population of Newark residents. One area hospital is experiencing an increase in patients with
late stage cancers. Because of the growing number of uninsured patients, many oncologists are
referring their patients to this hospital. Many such individuals, who once may have paid cash,
can no longer afford the rising cost of health care and are rely on charity care. With no oncology
clinics in the community to absorb the uninsured, many will arrive with late stage diseases.

Newark hospitals are seeing many more referrals from outside hospitals and more female than
male patients. One informant noted that “Males are very reluctant to come in for care unless the
females caring for them insist that they do so. The new male population is coming in with severe
health problems and without wives or significant partners. But they are falling apart because
there is no nurturing and support for them. This is the case mostly with the homeless, substance
abusers, illegal immigrants, and other poor individuals. We also see a lot of Hispanics now, due
to hospital closures in surrounding communities (Orange, Kearny, Irvington, Jersey City). Even
for those from the Newark area, the language barrier is a problem. They do not speak English
fluently, and get frustrated because they cannot explain their health problem adequately.”

Emergency Room (ER) staff have first-hand experience of the impact of hospital closings, large
uninsured population, increasing undocumented and substance abusing populations. One
informant noted, “We see all types of health problems as frontline staff to the community and the
health institutions that serve these communities. The problem, however, is now overwhelming
because of the preponderance of socials ills in our community. We used to see about 60,000
cases a year in our ER, now we are seeing 90,000 in the same space.” This is frustrating to
patients and staff and overwhelms nurses and physicians. The higher number of patients are
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 22

coming in sicker, which increases waiting time in the ER (8-12 hours), increases time to treat
them, increases inpatient referrals to fewer available beds, increases number of patients per
room. Triage of the sickest patients often results in others going home, and returning weeks later
in more severe conditions. “Patients are also staying in the hospital for social rather than
medical needs because there is no housing to send them back to. Many are now being brought in
by ambulance. In the past, it was a means of transportation, now they really are sicker.”

Reasons why the populations are coming to care is sicker include poverty, undocumented status,
lack of access to prescribed medications, and inability to navigate the health care system. The
influx of immigrants into the city also means an over-representation of diseases of the poor, such
as tuberculosis and selected cancers. Many of these immigrants live with 10 or more people in a
small room or one bedroom apartment. Many of them go hungry or eat a very poor diet, and turn
to drugs, cigarettes and alcohol for comfort. One informant noted an increased number of
patients with throat cancers, most of which are associated with smoking and excessive drinking.

In many ways the issues in the community are slipping into area hospitals at a time of dwindling
resources and increasing uninsured who cannot afford the cost of care. Poor coping skills of area
residents (e.g., gang activities, smoking, drinking, drug abuse) now translate to overcrowded
ERs, overcrowded inpatient departments, poor quality of life, and premature death. Informants
noted that they now see a lot of young people (15 to late 20s) coming in with stab wounds and
gunshot wounds. Many are suicidal at age 30 or younger; many are African American. There is
an increased number of persons of Portuguese descent presenting in the ER with wounds from
car accidents, while Hispanic day laborers are reporting injuries from construction activities,
because employers may not be following OSHA regulations but these undocumented employees
are unaware of their rights to protective gear.

Populations’ Services Needs and the Changing Landscape

The increase of African Americans among the city’s vulnerable populations is also a problem for
many agencies, which in the past may have served a largely Hispanic clientele (e.g., Puerto
Ricans) or a mix of African American and Latino clients. According to the U.S. 2000 Census
data, slightly more than half of the city’s population is black. For many area providers, however,
their target area has seen an exodus of the more affluent and stable but working poor population
that in the past was racially mixed. Left behind are the very poor blacks, the majority of whom
are substance abusers, persons with mental health problems or co-occurring substance abuse and
mental problems, displaced, near homeless, and those released from prison in the last five years.
These individuals now crowd area programs looking for long-term assistance.

Newer immigrant populations have their own set of problems including language and cultural
difficulties. While the dominant immigrant population has been persons of Spanish descent, the
city has yet to make area services better meet their needs, e.g., provision of all city services in
English and Spanish. Since members of this dominant group still have problems accessing key
services in their own language, the much smaller group of Haitian and Asian immigrant
populations are likely to encounter even more problems, with health and social implications.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 23

Other agencies now serve a population largely with substance abuse problems, rather than a
population of working poor who merely fell on “temporary” hard times or needed assistance to
help stabilize their lives. One agency that receives referrals from child welfare (DYFS) noted
that their average client had been a working poor or welfare person, lacking parenting skills or
with poor coping skills and may have been abusive or negligent with the children. These
individuals were taught parenting skills and then linked to other area resources to help meet their
transitional needs. Now, the bulk of the population seeking their assistance is comprised of
substance abusers, whose needs are more extensive and beyond the capacity of the organization
to handle. Clients need drug treatment and intensive rehabilitative services, as well as food and
housing assistance. Even those who received required training or assistance are unable to leave
the program, because many of the agencies which absorbed them in the past are now
overwhelmed with clients needing more extensive and long-term assistance.

The culprit behind the bottleneck in the system is the lack of affordable housing for clients to
transition into and the lack of more intensive substance abuse treatment programs. Hospitals
have found that discharging patients is daunting because many have nowhere to go after their
hospital stay. The majority of one agency’s clients share a room with other individuals or entire
families of three to five persons. The loss of privacy and human dignity that accompanies these
arrangements creates its own sets of problems, particularly among the children in these families.
The fact that many of these parents are recovering or currently using drug addicts is an added
stressor for the children and compounds the lack of a stable home environment. So, providers
are now seeing an increase in the number of children with mental health issues.

Not only are the new clients substance abusers with children, they are often HIV positive. They
require more specialized assistance as do their children. Some families have housing assistance
from Housing Opportunities for Persons With AIDS (HOPWA). The impact on children after a
parent with AIDS in this program dies is wide and varied. It includes school drop-out, low
literacy levels, teen pregnancies, homelessness, gang enrollment, gang violence, premature
death, increased exposure to HIV/AIDS, juvenile delinquency and/or imprisonment, car theft,
prostitution, and drug sale and/or use. This means is that the changing face of the population
now includes distressed children. While those under age 18 can be absorbed by many programs
in Newark, the group age 18 and older, who have gone through many of these services, now have
nowhere to go. Many of these children have not developed the requisite life skills and as a result
are unprepared to handle life on their own. Many are uneducated and lack comprehension skills.
The result is the predominance of health and social problems that are now widespread in the city.

It is not surprising therefore that some area providers are also seeing an influx of teen mothers, a
group they note is tough to work with. Often they are coming out of the foster care system and
are focused on survival skills (i.e., trying to determine where their next meal or extra money will
come from). They are often very angry, afraid, alone, scared, have no family support, and hence
tend to use street-based approaches to getting their way. As one key informant noted, “They
would say ‘I have a doctor’s appointment,’ when in fact they are going to see their boyfriends.”

A growing number of agencies are seeing an increase in the number of Caribbean Islanders
seeking their services, including more elderly from this cultural group. As one informant of
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 24

Caribbean descent noted, “The Caribbean community is comprised of three distinct groups: (1)
first- or second- generation immigrants who are now elderly population, (2) first or second
generation younger West Indian individuals, who may have accompanied their parents or were
born to these parents while in the new environment and who are the urban middle class, and (3)
adult, college or professionally trained Caribbean immigrants, including physicians, architects,
entrepreneurs, small business owners, engineers, and other professionals living in the greater
Newark area. The needs of these various groups differ, but the elderly suffer the same fate as
those of African American descent in Newark. Available ambulatory facilities are overcrowded
and inadequate to accommodate their health needs. They lack access to private transportation
and may be dependent on the younger adults to help meet their social and health needs. To the
extent that the elderly Caribbean Islanders are part of the black population, they now too face the
chronic health problems endemic among blacks - diabetes, hypertension, heart disease, and
cancer. They lack routine access to care and hence may arrive at the hospital by ambulance.

Selected Effects of Environmental Challenges and the Changing Landscape On Area

The impact of the changing population base is wide and varied. Local agencies are evolving and
trying to adjust to the changing community through comprehensive programs that help parents
care for their children the right way, including meeting their health needs, educational needs -
GED for the parents and school advocacy for their children, and their parenting needs. Agencies
link them to a network of programs to meet the wide range of their physical health, mental
health, and social services needs. “There is lots of demand on services and no funds to meet the
increasing needs for these services.”

Another provider-related effect includes a loss of client-base. Economic development in Newark
also creates a new set of problems. Social services agencies, such as child care centers located
nearer to the new construction sites, must increase their fees, further alienating their customer
base. The new residents may not utilize these facilities, so providers lose revenue. These
providers have to keep up with the increased rental cost by changing the way they do business
and targeting a new clientele. The nature of crimes (both violent and quality-of-life crimes) in
many of these neighborhoods makes it hard for area providers to attract new clientele. One
health care provider has been unable to attract residents from new homes surrounding their
facility because the new owners associate the facility with nearby public housing. The facility is
located in a high crime zone that even the trucks that frequented this area in the past to offer
mobile food pantry service now hesitate to serve this site, for fear of being accosted, harassed or
worse, killed for a meager amount of money by neighborhood gang members. Thus, the arrival
of a middle class population has not translated to improved patient mix for this provider.

Other agencies are partnering with other community-based programs to build organizational
capacity to help better serve the increased number of disenfranchised families. One agency
offers training on advocacy strategies, resource identification, and how to strengthen referral
mechanisms. The goal is to strengthen collaboration among agencies to enable them to better
serve their target populations in light of dwindling funding opportunities. The awareness is that
because many of these agencies cannot compete in the marketplace for salaries or staff incentive
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 25

packages, they are losing valuable staff. The cost of technology is also increasing, causing
organizations to shift funding that could have been used elsewhere. Organizations also must
now have staffers who are bilingual or tri-lingual, since many of the clients they serve speak a
language other than English. These agencies are developing creative strategies to help each
other, such as bartering for the exchange of services, and not cash incentives.

Community-Centered Issues

Newark is known for many things, including the New Jersey Performing Arts Center (NJPAC),
its baseball stadium, an international airport, the Newark Museum, Symphony Hall and for its
close proximity to New York City. For the most part, these treasures take a back seat to the
barrage of health and social problems that now confront the city’s residents. In spite of these
problems, our informants held that the city is bestowed with a large population of individuals
with a strong religious faith and belief in God, and that its residents have an extremely
appreciative spirit and a strong loyalty to the city. Additionally, members of the community
work hard to maintain the network structures they have, even when other environmental stressors
try to overwhelm these relationships. As one informant put it, “I am always impressed how
family members would rally around a patient, even if the family relationship is a dysfunctional
one. Members of the Newark community, even when considered poor, tend to offer help to
members of their social networks when such help is called for.”

Nonetheless, a series of issues were found to be of grave concern to those interviewed for this
aspect of the report. These included health, social, mental health, environmental, and economic
concerns. Some of these issues overlap, and are presented from differing perspectives
throughout this document. Informants are concerned about major health problems that are now
endemic to the Newark community. Many of these are preventable and/or treatable, but for
many of the city’s residents they are life threatening. Many of these health problems are linked
to lifestyle issues including poor dietary habits, substance abuse, smoking, and lack of exercise.
Others are associated with the structure of the health care delivery system that limits access to
quality health care, creates bottlenecks, or excludes members of various groups because of
immigration, financial ability, literacy levels, and/or employment status. What is troubling,
however, is the increasing impact of the social policies and the physical environment on the
population’s health, particularly as it relates to children and the elderly.

Health-Related Concerns. Priority issues identified by key informants include the spread of
HIV/AIDS and the increase in chronic disease conditions among city residents. HIV in Newark
now includes teenagers, who are said to know little about health and risk-reduction behavior,
women, and the elderly. The challenge for area providers is how to deal with the sexual
practices of high-risk teenagers, many of whom are having unprotected sex and need to monitor
their sexual activity. Also of concern that the gang members are now a public health concern on
a level not previously considered. Issues are two-fold: first is that some of the teenagers with
HIV/AIDS are forced to join gangs because they lack the appropriate informal support group ties
(such as a supportive parent) to provide the required supervision and guidance, and second, many
gang members are HIV+ because of their social behaviors including sexual promiscuity,
unprotected sexual practices, and/or previous sexual abuse. Some gang initiation activities
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                            Page 26

require that members have unprotected sex with the new recruits. These practices expose
members to many STDS prevalent in Newark including HIV, syphilis, gonorrhea, and hepatitis.

Major health problems endemic among Newark’s residents include diabetes, obesity (children
and adult), cancer (lung, throat, prostate, breast, and colon), hepatitis, STDs and HIV/AIDS,
psychiatric disorders (children and adults), heart disease, asthma and allergies (children),
disabilities (children), arthritis, lead poisoning (children), malnutrition (children and adults), eye
problems, and lupus. While these health problems may be common among other groups outside
of Newark, the concern among informants is the severity of these conditions among area
residents and the increased occurrence among the city’s most vulnerable population, its children.

Health Behavior. Besides specific health concerns, the populations’ health practices put them at
risk for poor health outcomes. The average patient uses the emergency room to access health
services. This may be the result of lack of health insurance, lack of transportation, the fact that
health is not considered a priority, and/or the mere fear of a potential health problem. Fear of the
unknown is common among residents, such that people would rather not know what is wrong
with them, as if it will go away, and many are making decisions without adequate information.

Because many of the city’s poor and immigrant populations do not have health insurance, they
tend to access care through the emergency room. ERs do not provide continuity of care,
particularly since they are now overwhelmed with demand for their services by a population with
poor health status. Some use the health department (Newark DHHS) for their immunization and
well-baby services, but generally lack medical homes for themselves and their families. These
populations do not have a regular source of health care and report episodic use of health services.

Health-Related Concerns: Children’s Health Issues. Asthma, lead poisoning, psychiatric
disorders, and obesity are among the major problems common among Newark’s children.
Informants agreed that the housing and the physical environment in which many of Newark’s
children live are often unhealthy, thereby increasing risk of these health problems. The nature of
their physical environment (e.g., dilapidated housing units, crime-infested streets, and adults who
put them at risk for molestation and drug use) creates an atmosphere of inactivity, with many
forced to stay indoors. Many parents, we were informed, smoke at home in units already in
dilapidated conditions. These situations further aggravates the cited health concerns.

A series of issues emerge as a result of the external (streets) and internal (home) environments to
which these children are exposed. First, children left indoors and away from the negative forces
of their external environment have lots of television time, as area parks are themselves
dilapidated and there are limited recreational activities for children. One informant noted that
Newark’s children are facing a very dangerous situation, and develop sedentary lifestyles and
consume excessive amounts of processed foods which increases risk of many health problems.
Second, television serves as babysitter for children and relieves parents who consequently do not
discourage children from watching it.

The way children are fed increases their risk of gaining weight and developing health problems.
Because children are indoors so much, they want to eat only the things they see on TV which are
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 27

not nutritious, but easy to obtain and prepare. Parents are happy to feed children foods that do
not take long to make, thus increasing their risk of obesity and its attendant problems. There is
an issue of poor nutrition among younger children, including infants. One informant noted that
her grandchildren now have Type II diabetes due to poor diet and the introduction of solid food
too early in their development, just so they can go to sleep and sleep through the night.

Newark’s children who stay indoors for long periods of time, we were informed, also play a lot
of video games to keep themselves occupied, which our informants argued does nothing for
brain development or critical thinking. “These video games do not stimulate the mind, and these
children end up not doing very well in school. It means that there is a health cost and a social
cost for children for staying in the house so much.”

Lack of external environmental safety is compounded by environmental pollution from trucks
and other vehicles passing through many poor areas, particularly in the South and Central Wards.

An increase in STDs and HIV among the city’s youth are associated with the decision to keep
children indoors. Youth are risk takers with a very active sexual life exposing them to STDs and
a litany of health problems that include depression, low literacy levels due to an inability to focus
in school, and substance abuse. To a great extent these negative social behaviors result from the
physical environment in which the children are raised. Many children are left unattended by
parents who are working multiple low-paying jobs to make ends meet. The children are
unsupervised or with other adults who do not have their best interests at heart. One informant
noted, “Parents work all day, leaving their young children at home. Many are exposed to adult
males (age 42 and over) who are introducing them to sex at very early ages and exposing them to
STDs and HIV, as are some of their peers. Many are exposed to hepatitis, an expensive disease
to treat and a health problem that no one wants to invest the funds required to reduce its spread.”

Other Community-Cantered Issues: Education. The community is also concerned about the
educational attainment levels of its children. They feel that the school system has failed the
children on many levels, and the outcome is a large population of children who are poorly
prepared to handle the rigors of the larger society. Informants noted increased violence in the
public schools which makes learning difficult and going to school unbearable for children and
their families. Because of their social and economic position, many children are said not to have
the proper attire, and are consequently ignored or mocked by their peers. This impacts self-
esteem, and learning becomes an additional burden for them. For some, it is not “cool” to be
smart; hence showing intelligence also increases their chances of being ostracized. The fact that
many children do not feel connected to their peers is an added stressor, particularly if the home
environment itself leaves much to be desired.

Lack of safe corridors surrounding the schools makes going home after school a daunting task
for parents, who wait anxiously to greet their children returning home from school. Children, we
were told, are even afraid to walk to the after school programs due to gang violence and the fear
of being attacked. One key informant whose agency plans to start an after school program in
January, and who is located within a one-mile radius of six area schools, is concerned that
students will not attend the program for fear of experiencing violence on the way. The
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 28

opportunity to attend an after school program, instead of being shut-in at home often without
parental supervision, raises additional concerns for these families.

The issue of under-employment and preponderance of low-paying jobs in Newark impacts
family life and school attendance. We were informed that many parents hold multiple jobs that
offer no health benefits or allow for paid time off. Individuals are penalized one way or another
if they miss a day of work. The outcome is an increase in the number of latch key children, who
are now younger than their predecessors. The change in welfare laws has forced parents to leave
young children at home to fend for themselves, due to the lack of financial resources and the
inability for parents to pay for child care. It was noted that too many young children are now
taking care of their younger siblings, which leads to increased absenteeism rate because these
children either leave for school late or are staying home to take care of sick siblings.

Informants were also concerned about the lack of access to higher educational opportunities
among immigrant children, who could become the city’s next set of problems in light of the
growing immigrant population in the city. Children from these immigrant families are required
to have lived in the country for five years or more to qualify for financial assistance. Informants
noted that many of these children are academically sophisticated and would like to attend
college, and could get into the best schools in the country, but for the lack of the required
documentation or financial resources. The fact that many of their parents work in cash-based
employment where there is little documentation of their income, makes it difficult for them to
file tax returns which are required for establishing income and a determinant of access to various
sources of financial aid. Further, many of these parents are also illegal in the country and do not
have the proper documentation for their children to be eligible for any government assistance.

These and other issues add to the city’s problem, increasing the preponderance of persons with
low literacy levels in the community. Increasingly, employers are looking for persons with
college education, who are in short supply in Newark. Even those with high school education
have comprehension deficiencies. This compounds the problem of high unemployment rate, and
increased dependency on government assistance among city residents.

Language Barriers. Linguistic problems were found to be commonplace in the community,
impacting the lives of a substantial proportion of the city’s population, including U.S. citizens
who do not have command of the language. These individuals, regardless of their places of
origin, have difficulty navigating jobs and health and social services systems. In terms of access
to health care, for example, as one informant pointed out, and confirmed by others. “When you
have doctors and nurses who speak only English, quality of care is compromised. If you are a
patient from Haiti, Venezuela or France, you’d have a problem. Patients don’t understand what
the doctor is saying, and don’t know how to explain their health problems to the doctor. The
problem gets exacerbated when you as a doctor are taking a case or covering for another doctor.”
The perpetual social distance and lack of trust between poorly educated and immigrant patients
and their doctors make effective communication and interaction difficult to achieve, and often
adversely affects motivation and compliance with medical appointments and medications.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 29

One informant pointed to the laissez faire attitude of health providers, and the perception that all
Latinos are the same. While there are similarities between Puerto Ricans and Americans, this is
not the case between Puerto Ricans and other Latin American countries, he found the approach
of providers regarding the care of persons of Hispanic origin disrespectful and marginal at best.

The language barrier also affects vulnerable populations’ ability to access social services.
Because many immigrants and low-income individuals are not fluent in English, they not only
lack knowledge about personal rights, they also lack access to key information on where and
how to access available resources. These issues compound the inability of this group to advocate
for themselves or to navigate the various systems (school, health, and social). More importantly,
they often feel disconnected from the health and social systems that are set up to help them.

Cultural Issues. Among the many issues of concern to the community are cultural barriers and
their implications for educational attainment, health, health care utilization, and socioeconomic
well-being. The lack of understanding of the influence of culture on these issue areas has been a
cause for distress among stakeholders in Newark, and creates a divide between the community
and the health services providers, which in turn impact health outcomes.

Cultural sensitivity surrounding the nature of parenting is needed because the number of
households with absentee fathers is on the rise, a new problem for the city. This is increasingly
due to the fact that many fathers are working long hours in low-paying jobs and are not around in
the home. This is a problem because these same absentee fathers are responsible for making key
household decisions, including those pertaining to health care. If a mother brings a child to care
she may have to wait until the father has time off from work to join them for the visit to complete
a course of care, such as a required surgical procedure. In some families, many more household
members have to be involved in the decision-making process, even for non-health care decisions.

Another informant further underscored the impact of culture on the range of issues affecting
Newark residents. The fact that the new immigrant populations have diverse cultural and
linguistic backgrounds means that the educational, social, mental health, and health systems must
adjust the way they do business to accommodate the new groups. Informants noted differences
in how Hispanic clients and African American clients participated in health education and
services, often depending upon whether members of their racial/ethnic group were conducting
the services, if conducted in Spanish, and methods of recruitment including word of mouth.

Lack of Affordable Housing. Informants spoke not only to the issue of neighborhood crimes
and their impact on physical and mental health, but also about the dilapidated condition of their
housing units, which they indicated are plagued by poor plumbing, mold, lack of heat, rodents,
insect infestation, and chipping paint. Lack of affordable housing dominates the health,
academic, and social discussion in Newark. The city’s revitalization effort translates largely to
demolition activities for many of its residents. However, many of the units left behind are also
infested with rodents and are in very poor condition. According to our informants, many of their
clients see little hope and hence are resolved to complaining about their rodent-infested homes to
their friends and not the authorities who can do something about the problem. Their lack of
negotiation skills compounds this problem. The outcome, however, is the development of a
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 30

mind-set that demonstrates their lack of ownership in the community and an inability to care
about their environment and the people living in it.

The displaced residents, who now have nowhere to go and must give way to occupants of the
newly constructed units, now find themselves at area hospitals asking for shelter or doubled up
with family members. Further, the demolition of housing in Newark has resulted in a shift or
movement of the displaced population to one specific area, causing a social problem for those in
these areas. With an overwhelming number of these vulnerable populations now congregated in
one area of the community, their social problems are concentrated and no longer dispersed.

As a result of the low-income housing shortage, hospital emergency rooms and inpatient services
are now serving as referrals for shelter placement. Because many of their patients are homeless,
discharge planning has become difficult. As one informant noted, the hospital now has to find
shelter placement for its patients before they can be discharged into the community. This
“frequent flyer” patient population seeks care at the hospitals, rarely takes medications they are
given, and, frequently return for care because they do not have the required support. The
population lacks funds for adequate rehabilitation, and so the hospital is their only source of care.

As informants noted, the construction of new housing units in the city itself is not enough for
area residents, particularly the disenfranchised. Community revitalization efforts have far-
reaching ramifications. There is a disconnect between new owners of these units and long-time
Newark residents. There is a sense of fear among the displaced whose properties now house
newcomers. Long-time residents are threatened by the economic development, particularly since
it has added little to their lives thus far. These individuals are not opposed to economic
development, but improvement in their community is lacking. Redevelopment activities appear
to be occurring at the expense of those least able to afford them. The buoyancy and optimism of
the revitalization effort, particularly with the change in the mayoral administration, has spurred
some sense of hope. But this is offset by fear, tension, wondering, and apprehension. Per one
informant, the question becomes, “Who will benefit from these changes?” The majority of
construction firms are from areas other than Newark which are not recruiting from area residents,
so the benefits are not that obvious to the neighborhood residents. The economic development
that the new construction was supposed to generate in the form of new jobs has not materialized.

Organization of Resources. There is a lack of a comprehensive, centralized community
resource, i.e., a one-stop-shopping place for families to go to for information regarding a variety
of issues; where heads of household can receive job training, health care, mental health
counseling, information about area services, updates on policy issues, and much more. Hence,
one local agency now offers support to parent groups, advocates for families in school and in
other areas, and conducts an intensive violence prevention program in elementary and middle
schools. Informants spoke on the need to provide a safe haven for youths, somewhere they could
go to find the type of assistance they need, including mental health counseling, primary health
care, sex and health education, tutorial, and mentoring services. One informant, speaking about
the issue of poverty and its attendant problems, reminded us about the multifaceted nature of the
problems facing Newark’s residents, and the need for easy access to essential resources. The
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Summary: Community Themes and Strengths Assessment                                             Page 31

lack of a place where children can go for help, or where parents can access a wide range of
resources, has implications for life in the city.

Social-Environmental Issues. Many issues are endemic in the Newark community. These
include substance abuse, low literacy levels, gangs and gang violence, poverty, domestic
violence, abuse and child neglect, unemployment, and under-employment. Although discussed
above, some are addressed here again to shed light on their impact upon the city.

Key informants all agreed that drug prevention programs were badly needed, since drugs have
invaded the homes, streets and schools. Newark has to deal with the problem of drug abuse and
alcoholism. One informant noted, “The children in our after school program are more a product
of substance abusing parents, parents with HIV/AIDS, and mental health issues. These are high-
need kids. We offer parenting skills workshop to help young parents strengthen their families.
But many of these children have been abandoned or labeled by the Board of Education because
of behavioral problems, and have no one to advocate for them or link them to the appropriate
services to meet their needs before they fall through the cracks of the educational system. The
parents are not equipped to deal with them because they also are dealing with substance abuse,
mental illness, and/or HIV/AIDS. In the past, when these women heard they were HIV+, they
cleaned themselves and tried to take care of their children. Nowadays, since they are living
longer, they tend to return to drugs. We must address their drug problem.”

There are the ever-present problems of car theft, robbery, murder (gun use and other crimes), and
other quality of life crimes.

Gang violence is another major problem facing the community. Many children involved in gang
activities have spent time in half-way houses. In recent years, there has been a resurgence of
gangs which impacts family life. One informant noted, “Parents are struggling to keep their
children safe, while gangs are pulling them on the other side. Grannies are threatening the
children not to join or they’ll be thrown out of the house, since for the most part they are the ones
raising the children. Children are being forced by gangs or be exposed to violence. The problem
is some give in and others face constant harassment. However, when they join, some of the
things they have to do at times is to engage in sexual activity with an HIV-infected person. That
exposes them to the virus and other health conditions such as hepatitis, which is a very difficult
disease to treat. If these children are doing well in school, they are targeted by gangs. Their
families are threatened if they fail to join the gangs. It is a Catch 22. If they join, the family gets
hurt anyway, because the children may die a violent death, become ill, end up in jail or addicted
to drugs. Their saving grace is if they join a mentoring program. That really helps them.”

We were also informed that stressors in the physical environment in which many of the city’s
residents live result in increased cigarette smoking (teens and adults, including women), and the
excessive use of alcoholism and other soft drugs as a means of escape. This practice also gives
rise to addictive behavior. One informant noted about her Central Ward community, “We see a
lot of heroin (snorting and injection drug use), a big problem in Newark. It is the favorite drug of
choice, followed by cocaine. Now there is the issue of pills such as Percocet. Alcohol use is
also a problem. But substance abuse leads to high incidence of HIV among our population.
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Summary: Community Themes and Strengths Assessment                                          Page 32

Many of these addicted individuals need to leave Newark to get clean, given their triggers are
here and they cannot get away from them.”

There is also the issue of community neglect. Informants noted that there are bars in every
corner of the city. While they are an eyesore, their presence illustrates the need for well-
structured alcohol prevention or alcoholism treatment and outreach programs. As with bodegas,
it lets you know where to focus community intervention targeted at specific groups. As one
informant pointed out, “While bodegas are great for the population they serve, they let you know
that you have a visible population of low income individuals who work in a cash economy, have
funds only for day-to-day shopping, hand-to-mouth type shopping, and have problems reaching
the larger supermarket. You know for sure that such community has large numbers of
individuals who are victims of urban decay, or who are at risk for factors associated with
community neglect. This population may have issues associated with poor nutritional health.”

Neighborhood decay impacts more than the physical environment in which people live. It also
affects the type of resources to which area residents have access. We were told that many cannot
come out of their homes for fear of confronting the decay in their community. Negative factors
discussed above make it difficult for health professionals and social workers to reach clients in
need of home services. Early intervention program staff who need to reach the children in their
care and to conduct home assessments are unable to do so for fear of being attacked or simply
because of the poor physical space in which many of their clients live. Home health aides and
home care nurses avoid going to patients in dire need of care, and even when they do go, they are
eager to leave to avoid becoming victims of the environmental problems. Many clients are afraid
to venture out of their homes to complete an exercise routine required for their recuperation or to
participate in the everyday activities of their community. Said one informant: “Many of my
patients can’t even afford normal life. Many live in neighborhoods that leave much to be desired.
Some require intensive home care, and can’t even afford that financially, and therefore are
unable to care for themselves. Many of them live in dangerous areas and tell us that they can’t
walk in their community to do exercise. The unfortunate thing is that there are no malls in these
neighborhoods that would serve as a safe area for them to take walks in. Some of these patients
are on ventilators, others need other sophisticated assistance. The home care workers don’t want
to go to these areas, and when they get there to help the patients, they are quick to leave. These
patients have terrible health outcomes, and it is only going to get worse for patients like these.”

Informants also noted that to a large extent the community is generally hazardous to the families.
There is a shortage of fresh foods such as vegetables and fruits in local stores. The nearest
supermarket is often a good distance away from many who need its services, and even when
close by, these facilities may not offer fresh meats, chicken, or vegetables because owners are
aware that they serve an uninvolved and non-demanding customer population. As a result,
families are forced to make do with what is in their communities. Even when fresh items are
sold, the price is too expensive for many customers, while junk food is cheaper. A bag of potato
chips is $0.25, while an apple could cost up to $0.75. More importantly, parents are often so
emotionally drained by the time they come home that they are not willing to invest the energy to
get a child to eat a healthy meal, especially when television ads are telling them to eat junk food.
It is far easier for them to throw a frozen pizza in the microwave than to prepare a healthy meal.
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Summary: Community Themes and Strengths Assessment                                          Page 33

Mental Health Issues. The issue of mental health as a prominent health problem is evident
throughout this document, but youth are most at risk of mental illness and who are raising
concerns among stakeholders are the youth. Adult mental health issues are attributable mostly to
substance abuse, although it is unknown which problem manifested first. The adolescent mental
health problem is multi-faceted, and is fast becoming a major health concern for the city. The
issues of substance abuse and HIV/AIDS and their impact on young lives cannot be
overemphasized. Many of these children have parents who are either substance abusers, have
mental health problems, and/or have HIV/AIDS. The presence of these problems in families has
major implications for the children. Many cannot share their problems with peers for fear they
will be ostracized. The children of these infected parents are dealing with HIV/AIDS and cannot
tell their peers, afraid that they will be abandoned or rejected. These issues create added stress
and may lead to mental health problems. Of major concern to working with this population is
the fact that the death of a parent tends to have a trickle-down effect, creating severe mental
problems and a socially stressful situation for these children. The availability of early
Permanency (Placement) Planning for these children before the death of their mothers would go
a long way to relieve their stress, stabilize them, and enable them to develop healthy self-esteem.
The goal is to help enforce kinship care and standby guardianship. The point is made that the
children from these homes are often depressed after the parent dies, are often sexually exploited,
exposed to STDs, teen pregnancy, substance abuse, and gang violence (beaten and shot or
stabbed). The lack of informal social support systems for many at-risk individuals exacerbates
the problem. The elderly who once stood as matriarchs in the black community, and the
godmothers in the case of the Hispanics, now have to work well past retirement age, and are no
longer readily available to assist their family members or informal group members in providing
instrumental, financial, and much-needed emotional support. The loss of these individuals in
many families is evident in the nature of life in the city. “They are not helping like they use to.”

We were informed that many of the city’s youth are suicidal. Even among those who have
support of grandparents, many are dealing with other hardships, which makes taking care of a
grandchild -- whose parent is a substance abuser or died from HIV/AIDS -- all the more difficult.

The pervasive problem of mental health in our community is evident in the spread of gangs
across our city. Informants noted that there are now more than six different gangs in the city,
including such known ones as Bloods and Crips and several Latin American gangs. Many of
these gang members themselves have emotional problems. As one informant indicated, “They
are mentally ill.” Many had never received compassion and/or genuine understanding from a
parent, since the majority of their parents were never emotionally or physically available. They
may have been dealing with other social issues, such as sexual abuse or teenage pregnancy, and
may not have developed adequate parenting skills. Consequently, the usual detachment common
among these parents and their children aggravates mental and emotional issues, and could lead to
low self-esteem. One informant noted that the fact that many of Newark’s youth cannot resolve
a simple conflict without the use of guns and/or knives is itself a sign of mental health
deficiency. The inability to manage anger underscores this problem.

Barriers to Adequate Health Care. There are many issues that impact the population’s ability
to access early and appropriate care. Some of these factors are personal in nature, some the
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Summary: Community Themes and Strengths Assessment                                          Page 34

result of systemic issues that are beyond the capacity of the population to handle, and still others
involve a combination of both systemic and individuals factors. These may require concerted
effort on both parts to minimize their influence on access to care. In this section, we seek to
examine factors that influence health care use, in a bid to identify areas where the city and its
stakeholders can make an impact.

Individual-specific issues include the lack of informal social support, lack of health knowledge,
lack of transportation, fear (of negative health diagnosis and fear of deportation), lack of
relationship with doctor outside of the ER, lack of continuity of care, lack of compliance with
appointments or medications, inability to afford the medications.”

Lack of Health Insurance Coverage. A substantial proportion of Newark residents do not have
health insurance, which gives rise to the use of emergency room services, late health care-
seeking behavior, increased use of traditional medicines as an alternative source of care, and the
presence of persistent chronic health problems from preventable or treatable health conditions. In
fact, the lack of health insurance means an inability to buy required drugs. The working poor are
the hardest hit - they do not have Medicaid, lack funds and must pay cash for health services and
prescribed drugs. As one informant noted, “How often can you seek adequate care when you
have to pay cash for care, and then have to buy the medication that the doctor is prescribing?”
Some community-based health clinics charge low consultation fees so that their patients can use
the money saved from their health visits to buy medication. However, one informant observed,
the effort is hardly enough to impact the problem since many patients work in cash-only jobs.
Physicians may struggle to identify the less expensive medications, which may not be best for
their specific condition but are preferable to doing nothing to help them.

Barriers to Care: Health Care Systems Issues. While the population has little control over
systems-related issues, some issues can be better addressed to minimize their impact on the
health care consumer if the providers take time to understand or examine them. These issues
include the social distance between consumers of health care services and the institutions and
providers who serve them, availability of convenient hours, waiting time for care after contact
with a health facility, health insurance reimbursement procedures, lack of cultural sensitivity,
and poor patient-provider relationships. One informant noted, “Health providers are not trained
to recognize the human element in care. They expect the average person to have the level of
sophistication that they have; hence, the disconnect between health practitioners and their
patients. There is also commercialization of medicine, which allows physicians to spend little
time with their patients, not permitting any type of bonding or understanding about the causes of
their health problems. These providers are paid by the minute, so 15 minutes per patient is all
they can afford, and most of the time, not even that much time is spent caring for the patient.
They do not provide the amount of time that the patient needs to meet their true needs. Many of
our health clinics are based upon dollars and cents per square foot. For Latin populations, when
someone is sick, the entire family goes to care with them; this includes cousins and nephews and
uncles and aunts. Since these health facilities do not have adequate space, they discourage such
encounters, and these individuals may present alone, and have others from the institution serving
as translators. This gives rise to distrust, animosity, and non-compliance. If you do not trust a
practitioner, how are you going to listen to the instructions they are giving?”
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Summary: Community Themes and Strengths Assessment                                          Page 35

The fact that providers spend little time with their patients once contact is made, does not allow
for strong patient-provider interaction. Informants noted that the majority of health care
providers are neither friendly nor cordial, and hence patients are afraid to ask relevant questions
about their care. These patients are afraid they may be asking the wrong questions and by doing
so are exposing their lack of knowledge and vulnerability. Also, the gap between patients and
providers may be created in part by rude receptionists and other unfriendly frontline staff. Yet,
this interaction may change the patient-provider relationship, creating a barrier to adequate and
timely health care. It is evident that lack of health navigators is an ever-present problem in
Newark hospitals. Foreign-born patients who also come from poverty and did not attend school
in their home countries are experiencing difficulties in dealing with the health care system.
These individuals are important to the city given the changing population base; hence, the
increased need for health providers who are sensitive to the new group of patients.

Overcrowded Health Care Providers. Long waits in private doctors’ offices, community-
based health centers and emergency rooms all contribute to delayed care. Providers argue that
patients are sicker because they are coming to care late in the disease process. While this may be
the case, patients themselves blame factors associated with the delivery system. E.g., many
patients note that area health care providers would not accept their insurance, so they spend time
trying to locate one that does. s a result, these facilities are overcrowded, because only a limited
number of physicians provide care to those with the specific insurance, the uninsured and those
with Medicaid. These population groups have differing problems, but share a common
denominator: a limited number of providers serving the poor.

Gaps in Service Delivery

Health Education. There is an absence of health education programs in the area, including
those offering smoking cessation education, sex education, risk-reduction behavior education,
and sexual negotiation skills for youth and women. In terms of the later, one informant noted
that many poor and vulnerable women have contracted HIV and other STDs from husbands,
finding out only during prenatal care. Yet these wives are reluctant to tell their partners about
condoms, afraid of offending their partners or giving the impression they learned about condom
use from sexual contact outside the relationship.

Access to health education is important because it has the potential to address a wide range of
issues. Health education should address symptoms and the need to seek care sooner. This is
because the readmission rate for many common health problems in the city is too high and often
outside the norms elsewhere. Because many of those with chronic health problems from
preventable and/or treatable causes are the poor, hospitals discharge planners have a hard time
sending these patients home. Many patients, when discharged, must stay on a salt-restricted diet,
take certain medications, refrain from smoking, and keep their follow-up appointments. These
issues are difficult to adhere to because the population lacks awareness of the true nature of their
health problems and the importance of the required behavior change to their recovery. Thus,
health education is needed to increase the community’s knowledge about the human body and
the many diseases to which they are susceptible.
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Summary: Community Themes and Strengths Assessment                                          Page 36

Community health seminars are a good starting place. Those offering such services should use
varying approaches and venues to entice the community, including use of incentives, and holding
sessions in churches, senior citizen centers, and/or at the homes of selected individuals. E.g., the
Tupperware party model could prove beneficial for health educators seeking to reach difficult
populations. Hence, educators could host small educational sessions (groups of 10 to 15) at
homes of known key informants or disseminators among the various population groups.

Smoking Cessation Program. Smoking cessation programs are vital to the city’s effort to curb
many of the chronic health problems that now plague its population. Informants noted that many
patients are on a fixed income, and smoking behavior affects both their health and survival
issues. The importance of access to smoking cessation programs cannot be over-emphasized.
Informants noted that many patients are on a fixed income, and their smoking habit impacts their
finances. They are unable to purchase needed mediations, as cigarettes are a priority for them.
Further, cigarette smoking has been found to increase risk of many diseases, including heart
disease and lung cancer. It is also the case that children whose parents smoke have an increased
risk of developing asthma and other respiratory conditions.

Community Outreach. Informants noted the need for intensive outreach and nursing outreach.
The goal is to have nurses go to the homes of discharged patients who have severe health
problems and give instructions on how to manage heir health conditions post-discharge. Such
nurses, we were told, could provide the doctor with updates once at the patient’s house, so that
the doctor can make timely and informed decisions. This would reduce hospital re-admission
rate, as well as minimize the re-occurrence of some health problems. It would also reduce
emergency room visits, which is where most of these patients are entering the system.

Because many Newark families are vulnerable, from abusive homes, with little education and/or
comprehension skills or language ability, community outreach by paraprofessional staffers has
the potential to bring them into care early, equip them with vital information, enhance their
ability to make much-needed health care and social services appointments, and provide much-
needed skills training in their own environment.

Convenient Office/Program Hours. Many area providers, including social services programs,
do not offer convenient hours. Many social service organizations in the community serve as
gatekeepers for access to other systems, including education and health care. These programs
must accommodate needs of the vulnerable populations they serve. Consumers must be seen as a
valuable part of the organizations serving them. Their needs must be factored in when providers
are making program or operation plans. Long working hours, lack of access to private
transportation, and multiple children mean that conventional program hours may be incompatible
with their needs. Evening and weekend hours might be offered with community input. Many
programs have added evening hours without a corresponding increase in utilization of services.
Programs should involve their clientele in such decisions to better understand factors influencing
utilization behavior and incorporate this information into service delivery plans.

Informal Social Support Networks. Informants also spoke about the lack of informal social
support systems for many area residents, which in the past have served as a buffer for most
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Summary: Community Themes and Strengths Assessment                                             Page 37

stressors. These support systems include strong ties to godmothers, and grandmothers in the case
of African Americans. Among area blacks, e.g., mentoring programs and grandparent support
groups are in short supply, and many young men and women who could utilize the support of
these informal support network members are falling through the cracks of the health, social, and
educational systems. The availability of strong kinship ties, a valuable resource which reduces
foster care placement and other social ills, is tantamount to access to formal resources such as the
welfare system. Without such informal support, the resources provided by the formal systems,
like welfare fall short in their ability to make a meaningful difference in the lives of their clients.
E.g., it is important to set up mentoring programs, so that schools (a formal system) can be better
able to perform their role functions. When mentors (informal support) are able to provide advice,
emotional support, and more to vulnerable youths, it makes learning that much easier for them.
Among Hispanics, the call has been for the re-establishment of the Godmothers Club, which
offers instrumental (e.g., babysitting), emotional and other assistance to vulnerable families.

Mental Health Services. There is also an absence of mental health programs geared towards
children and adults. The community is likely to benefit from a strong mental health program.
As one informant observed, “When children pull out guns during an argument, it is because they
have anger management issues. They are unable to solve the problem amicably, and together.
There is a mental health problem within that.”

Further, with the increasing number of HIV cases in the city, the need for mental health
intervention will rise. When an individual is diagnosed with HIV, he/she needs mental health
assistance. Persons with HIV/AIDS have an increased likelihood of developing mental health
issues, and some may even need to be medicated. It is common knowledge at the CDC that for
every HIV+ individual, there is another who is HIV+ and does not know it. For every individual
in treatment, there is another who chooses not to get treatment because he/she is still in denial,
may not be insured, is afraid of being isolated and rejected, does not know how to navigate the
system of care, is suspicious of the health care system, has only charity care or Medicaid, is poor,
or is in jail. There is a need for counseling, psychiatric services, nutritional counseling, and
chronic disease management services. These programs are currently in short supply in the city.

Family Strengthening Programs. Informants also spoke on the issue of the foster care system,
and the role played by the Division of Youth and Family Services (DYFS). It was felt that this
major child advocacy group should develop safeguards that promote family strengthening and
minimize crisis resulting in family displacement. Since an increasing number of children are
entering the system, it is likely many of them will age out unprepared to handle adulthood.
Many of those age 18 and over who have left the system struggle to create a semblance of
normalcy, but lack required skills to do so. When children age out of the DYFS system, they do
not have access to many services previously available. They are often left on their own, ill-
prepared to face life or to take responsibility for themselves. These children join gangs, commit
crimes and end up in jail or dead. On one street in the Central Ward, three youths were gunned
down in one week, and in the South Ward, a memorial to four individuals outlines the streets.

These cases evidence weak family relationships in our community. One informant pointed out
that the new mayor wants to address the issue of crime, but that it is not enough to put people in
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Summary: Community Themes and Strengths Assessment                                         Page 38

jail when the system is able to catch them. There is a disconnect between the population and the
powers-that-be. Limited effort is put into finding workable solutions to many of the city’s
problems, because the root causes are not being addressed. The issue of gangs, for example, is a
precursor to crime and drug use and addressing gang violence has the potential to resolve these
two issues. But the home environment is important in this process. Thus, activities to strengthen
families so that young people do not have to belong to these types of groups will also help reduce
crime, drug use and exposure to diseases such as STDs and HIV/AIDS.

Programs that strengthen families should also include those that address the needs of women.
The presence of a nurturing family has the ability to curb crime, and is critical for the growth of
children. However, the point was made that women sometimes are more concerned about the
health of their families -- feeding the children, taking them to the hospital and more -- and as a
result neglect their own health problems. Consequently, these women are entering care too late,
and are unable to help their families because they are too sick to take care of themselves.

Provision of Integrated Care. There should be coordinated efforts to integrate health care. The
health care delivery system should be such that when a patient comes for diabetic check up, they
are monitored for hepatitis, HIV/AIDS, nutritional health, blood pressure, etc. This approach is
likely to increase continuity of care. Per one informant, “Many patients do not present with a
single need, say HIV/AIDS, but have a variety of needs.” It is evident that establishing a
continuum of care is very difficult, since area hospitals and providers complain about delayed
reimbursements and very low reimbursement rates. Lack of adequate state compensation to
hospitals at the level at which they are providing charity care, or acknowledging the increasing
number of persons receiving such care, means these facilities are not poised to encourage
individuals to return for follow-up care. They are likely to offer the barest minimum of care.

Development of an Information Warehouse. Informants spoke about the lack of access to a
single source of information, a database that captures data on the wide range of issues that need
to be studied to know more fully what is going on in the city. Every funding source has its own
data system and data collection requirements, but citywide monitoring and data collection for
assessment and evaluation purposes are essential to design an adequate health plan for the city.

Providers must work together, using existing data, to design programs to address core problems
in the city. This requires development of strong collaborative relationships among once-
competing agencies if the goal is to better help at-risk individuals. By sharing information and
ideas, these agencies can begin to uplift the city in a variety of ways. Access to a database can
help providers know more easily which areas would benefit more from the services they offer,
and those that would be better addressed by others, even if bartering is used.

Reimbursement for Area Providers. Social service providers need improved reimbursement
systems, particularly for services funded by the city. Many agencies do not have cash reserves
and operate on small budgets. Since many offer a wide range of wrap-around services to their
clients, e.g., housing residents, waiting times of 6-10 months for reimbursement means both the
agency and their clients suffer. Often, some of these agencies must take bridge loans from
lending institutions at a high rates to meet their financial obligations.
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Summary: Community Themes and Strengths Assessment                                          Page 39

Affordable Housing. Housing is a major issue for our population. This includes emergency
housing, transitional housing and boarding homes. A substantial proportion of the population
served by many area providers, including hospitals, lack permanent addresses, making follow-up
health care difficult. One informant noted that there is more demand for housing among
agencies that offer shelter as well as care. One agency gives out 60 housing vouchers monthly
through funding from the New Jersey Department of Community Affairs, and reported having 35
new requests for housing each month of which they can only process 10. The inability to offer
more housing assistance has created a backlog for this agency, with a waiting list of 200 families.
The lack of stable housing makes living difficult, continuing the cycle of poverty for those with
children into the next generation. It is extremely difficult for vulnerable persons to locate and
maintain meaningful employment without permanent housing. The mental anguish which
accompanies the ever-present risk of homelessness, even if one is doubled up with friends or
family members or residents in a temporarily shelter, is overwhelming.

Multi-Service Center. There is a lack of multi-service facilities where young people can go to
help meet a range of health, social, mental health, and economic needs. Informants talked about
the increased number of drug-addicted youths, and the issue of mental health problems among
this vulnerable population. This would include youths who consider themselves to be gay,
transgendered, bisexual, and those with other sexual variations. Many of these youths are
fatherless - with parents in jail, on drugs, dead or murdered. There is also the issue of poverty,
hopelessness and intergenerational drug use (grandparents, parents, and now their children).
Such a facility should be located close to the school to minimize travel time, and should offer
counseling, mentoring, health services and educational assistance among its many services.

Neighborhood Health Clinics. Community health centers, which offer a comprehensive array
of health care services, are needed in many of our neighborhoods. The goal is to increase access
to prevention services and primary health care. These efforts are likely to reduce ER use by
serving as a source of regular health care for non-urgent problems. Those serving the poor and
disenfranchised must change the way they provide health services and involve patients in the
care process. There is a need to get patients to attend meetings/case conferences to get their input
into their care. This would help address issues related to waiting time and patient sensitivity.
Community clinics by design are less intimating to the population than the large hospitals. The
social distance between providers and patients is minimized, and clinic patients see individuals
who look like them. These facilities encourage walk-ins and their clientele may walk to care,
negating the issue of bus fare and transportation barrier that may lead to deferred health care.

Improve Patient-Provider Interaction. Informants noted the need to train staff to value their
work, to know its importance, and to remember that they are dealing with human beings who
come to them with illnesses at a time when they are very vulnerable. Courteous care is important
in the healing process, and patients who are treated with kindness are more likely to have a
higher compliance rate. As one informant noted, kindness and courtesy are attributes of care that
do not cost the practitioners anything. However, for the most part area providers act as though
they are doing their patients a favor. A positive attitude change is likely to increase the
community’s acceptance of area providers and the services they offer. There is also a need to
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Summary: Community Themes and Strengths Assessment                                          Page 40

include ER practitioners in health planning for the city. These individuals have the pulse of what
is going on in the community. “We tend to see it first, and can identify when a problem is
expanding or becoming more prevalent and call in the decision makers to take action.”

Staffing Issues. Increased recruitment of technical staff in area hospitals should be a priority,
given the increased demand for health care due to hospital closings and increased number of
uninsured patients shifted from other hospitals reducing their charity care. Many staffers are
serving as health navigators, which takes them away from their own work and creates a backlog.

The city must find a way to bring new doctors into town including use of incentives. The city’s
new residents are largely the uninsured. One informant observed, “I have never seen many of
these patients, who may have been going to doctors who have moved or no longer want to see
them. The remaining few have high office costs which are driving away their patients.” Another
reported, “I have patients who have to wait 3-6 months to see a specialist. Some have high blood
pressure and must take their medicines. They’ll call their doctors for days without any response,
or can’t go to see the doctor because of long waiting time.” These problems might be addressed
by a concerted effort to recruit and incentivize physicians to practice in high-risk neighborhoods.

Transportation. Lack of transportation is a barrier to care, hence the need for transportation
assistance to help improve compliance for follow-up care. One informant noted that availability
of transportation should accompany a campaign on the importance of follow-up care. Many
charity care patients arriving at health care facilities by private transportation cannot afford the
parking fees (e.g., area hospitals). We were told that many drive around the area looking for free
parking, which costs them valuable time. Some informants reported that at times these patients
are forced to reschedule their appointments, which becomes a real problem as appointment wait
times of up to three months is not uncommon. Also, for those lacking private transportation,
dealing with the maze of public transportation is a daunting task, and impacts health care access.

Employment. The city has never developed a comprehensive strategic approach to employment
of its residents. “Whatever is in place is a haphazard, disjointed, disorganized social process
which works under the rubric of ‘catch as catch can,’” said one informant. This means that the
school system must strive to prepare its students for a hopeful and productive tomorrow, so that
the city’s children grow into adulthood well-prepared for the work force and to face the world.
This would minimize the number that resort to committing crimes, selling and using drugs,
stealing cars, and succumbing to alcoholism because that is what they often seen around them.

Innovative Health Care Delivery. The nature of the population served by area health care
providers lends itself to innovation in health care. Many patients lack the financial resources to
purchase equipment needed for their home care needs, and the current staff shortage means a
lack of nurses to provide much-needed follow-up home visits. Hence, many patients return to
the hospital shortly after discharge. This adds to the health care cost and affects the nature of
care provided to the larger population of uninsured, underinsured, and other poor patients. Thus,
health care providers must rethink how they offer care to the increasing population of
disenfranchised patients, particularly those in need of more sophisticated home care equipment.
Health insurance companies should also pay for the new research methods that some area
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                             Page 41

providers are using to treat their patients, e.g., a non-invasive ventilation technique to treat spinal
muscular diseases. Many with invasive procedures have poor outcomes because they do not
receive adequate home care. They develop infections and cannot afford needed equipment. The
use of a non-invasive technique means faster healing time, decreased need for technical
assistance at home, and decreased hospital cost as patients won’t have to return for care so soon.

The Need for a Renewed Sense of Hope. “We have been listening to the new mayor, and
believe his heart is in the right place, so we think he really is going to do something about many
of the problems now plaguing the city,” said one informant.

Summary of the Community’s Need for Selected Special Services

1.     HIV/AIDS Prevention
       a.    Case management
       b.    Risk reduction education
       c.    Group sessions
       d.    Individual counseling for HIV-negative persons to maintain their sero-negative
             health status
       e.    Counseling for HIV-positive persons to change their sexual practices
             i.      Testing
             ii.     Intensive outreach
             iii.    Ethnographic studies to identify where specific at-risk groups can be
                     found: IDUs, MSMs, gangs, bisexuals, street walkers
       f.    Arm women with improved sexual negotiation skills
       g.    Need specialized programs, e.g., NJ Women with AIDS sister program
             i.      Address their specific needs
             ii.     Increase positive interaction with partners
             iii.    Provide relevant skills
             iv.     Syringe exchange program

2.     Housing
       a.    Case management for at-risk population to increase access to adequate housing

3.     Coordination of care
       a.    Access to continuum of care for patients with diabetes, HIV/AIDS, hypertension,
             heart disease, and other related chronic health problems
       b.    Offer programs that entice and encourage new doctors to establish practices in the
       c.    Identify best practices among health care providers in Newark or outside, with
             recommendations on how they can be adopted by local providers citywide
       d.    Increase access to preventive services, and increase reimbursements to these
             services by public or private insurance programs. The city’s policy makers can
             help in negotiating this aspect of the plan
       e.    Work with area hospitals to address length of stay constraints (JCAHO), while
             ensuring adequate post-discharge care and healthy outcomes.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 42

4.    Community’s enrollment in clinical trials
      a.   Gain trust
      b.   Link residents to a wide range of social services, such as housing, food pantries,
           and other programs that meet basic needs
      c.   Develop a workable approach to reaching and treating undocumented immigrants.

5.    Health providers with convenient hours
      a.     Early morning
      b.     Late nights
      c.     Saturdays or weekends
      d.     Increase capacity of the health system in Newark.

6.    Health navigators to make the system more client-friendly
      a.     Individuals need assistance communicating with doctors
             i.     Ask the right questions
             ii.    Participate in their own care decisions
             iii.   Many have not been to the hospital since birth. These facilities are
                    confusing and frightening and impersonal, as well as expensive
      b.     Understanding the medications they are prescribed
      c.     Receiving quality health care

7.    Social programs
      a.      After school programs
      b.      Summer jobs
      c.      Planned employment opportunities for adults (more blue collar jobs)
      d.      Teach families how to prioritize their resources and needs (how to address needs,
              not wants; how to buy fresh fruits and vegetables, not $80 designer sneakers for
              six-year olds).
      e.      Give children something to hope for (start them early on job training)
      f.      Create a center for teens, where they can be taught how to negotiate relationships,
              and what a healthy, productive social relationship looks like. The goal is to
              improve their self-esteem to enable them to set individual goals for themselves
      g.      Increase access to drug rehabilitation programs.
      h.      Strengthen the educational system so that more of the population can graduate
              from high school and enter college.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 43

                                Qualitative Study – Part 2
                                Focus Group Discussions

Focus Group Discussions with Various Groups of City of Newark Residents


The purpose of focus groups was to gain additional information about the city’s residents on a
broad range of issues that could better be addressed by the use of a qualitative research method.
Newark DHHS also sought to engage the community in its effort to develop a well-rounded,
grass roots-driven health plan for the city’s multi-cultural, multilingual residents. As a result,
enormous effort was made to identify the various groups that comprised the population of
Newark, taking into consideration such issue areas as the dominant race/ethnicity, language, age
and area of residents. These characteristics were deemed important in determining the audience
best-suited to offer information about issues of concern to area residents and in improving our
knowledge of some known barriers to care.

The focus of this data collection method was to gather additional data about residents’ concerns
relating to their neighborhoods, major health and social problems, the impact of neighborhood
problems on health, community resources and opportunities, access to health care issues, use of
area resources, and opinions regarding area health care services. Aspects of the focus group
discussions centered on items on the structured survey questionnaire that needed clarification.
There was a need to identify specific barriers to care and factors influencing health care use
among residents of the wards, and crucial open-ended comments made by survey respondents.

Note: While a broad range of individuals and groups participated in the focus group discussion
sessions, information offered by participants cannot be projected to the general population of
Newark residents. Nonetheless, it is hoped that the sessions will enable the Planning Partnership
to more effectively uncover factors relating to some of the more complex issues identified in the
various approaches undertaken to uncover issue areas of concern to city residents.

Sources of Data.

Information in this section was generated from more than 100 focus group participants. A total
of 30 focus groups were convened in the city’s five wards – North, East, South, West, Central.
There were a total of six groups per ward. In each ward, attempts were made to obtain data from
the youth, the elderly, males and females (in separate groupings for those other than the elderly)
who were drawn from three age groups – 18-24, 25-64, and 65 and over, and four dominant
racial/ethnic groups in the areas as determined by the 2000 Census. These groups included
African Americans, Hispanics, Haitians in the West Ward, and Brazilian/Portuguese in the East
Ward. Effort was made to reach the dominant groups in each ward whenever possible. Hence,
residents’ participation was diverse with respect to ethnic background, income, and health status.
These groups provided a rich source of data for the focus group discussions.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 44

Focus Group Size. Each focus group was comprised of at least eight participants. The purpose
of the design was to have a group sufficient enough to provide needed information for their
specific subgroups (e.g., youths). Group size ranged from eight to 20, dependent on availability
of group members, the ward and the venue selected for the focus group discussion. It was not
unusual to assemble as many as 20 youths for a focus group when sessions were held at local
high schools and community-based organizations serving this population. This was also the
case among the elderly. Senior citizen programs had the potential to solicit support from their
members. Participation in each focus group session was voluntary. The sample size provided a
group size that sustained the range of discussions required for this research.

Participant Selection. Focus group participants were drawn from the membership of each of
the organizations or institutions contacted for participation. Inclusion criteria were merely that
the participant is a resident of Newark and a member of the specific group targeted for the
session. There was also a gender requirement to maximize discussion of more sensitive issues
that would otherwise have gone unaddressed if the group had included both genders.

Prior to undertaking each focus group session, Newark DHHS staff obtained permission from
agencies agreeing to participate and provide members for the session. Hence, participants were
recruited with help of these agency staff. Recruitment of as focus group sites sessions was based
on the target population served, relevance of the population in the community, and the need to
generate data from the specific group. Agency staffers were asked to invite between eight and
16 individuals who lived in the area and fit the specific criteria requested for the particular site.
The participating agency staff were asked not to attend the sessions so as not to inhibit discussion
of sensitive issues which might not be shared if agency staff were present. Exceptions were
made when translation assistance was needed and where staff members made broad decisions for
their target population. (This occurred at a community center in East Ward serving a largely
Portuguese-speaking elderly population, which provided assistance for their health care needs.
Clients felt more comfortable describing specific issues to agency staff, who then translated
responses to the research staff. Research staff of Portuguese descent who spoke the language
were able to provide additional insight into the group dynamics and responses.)

Focus group participants were offered incentives for their participation at the end of each session
including refreshments and a gift of $25. Each participating site also received a $100 incentive
packet for hosting the session. Site participation was restricted to two groups to ensure access to
a wider public and obtain information from a broad spectrum of the population. Participants
were readily available at the time of the sessions because agency staff had made specific efforts
to disseminate information about the event and recruit appropriate target populations.

Focus Group Sites. Focus group sites included community resources such as public housing
units, senior housing complexes, community-based organizations, drug treatment providers,
youth-based providers, child care centers, medical day care programs, recreational facilities,
churches, and area high schools. Groups were held in places where the target population
congregates to provide greater access to specific groups of residents and allow participants to
take ownership of the specific sessions due to familiarity with the sites. Concerted effort was
made to reach the more difficult-to-reach groups, including the city’s Haitian population.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 45

Staffers at the participating agencies were helpful and enthusiastic about the opportunity to
engage their residents in discussions about pertinent issues as health care and barriers to care.
Not only did the sites provide sufficient respondents, but they also provided a safe haven for the
participants. It was not uncommon for participants to advocate for their particular site during the
discussion. Since they felt comfortable in their surroundings, it was easier for them to contribute
opinions, insights, and knowledge for analysis. Participants also expressed increased knowledge
of emerging health and social issues in their neighborhoods and had a chance to offer solutions to
some of the problems impacting neighborhood health and well-being of Newark residents.

Measures. A semi-structured interview guide was developed to conduct focus group sessions
and investigate issues regarding quality of life, health care consumption behaviors, barriers to
care and more. The guide was created with extensive input and contributions from Newark
DHHS staff and Planning Partnership members. Additional follow up questions were asked to
provide greater insight to the community’s needs, strengths and gap areas.

Focus Group Activities. Focus group sessions were held at times convenient for both the site
providers and the participating public. For example, sessions were held at 10:30 a.m., noon or 4
p.m. Even when sessions were held during later hours, all sessions were completed by 6 p.m.
when many had to go home and prepare dinner for their families or pick up their children from
day care centers and/or after school programs.

Participants were told the discussion sessions would last 60-90 minutes. Fifteen minutes would
be used to discuss “housekeeping issues” including the reason for the focus group, disruptions,
the need to tape the discussion, and to inform participants about “late arrivers” or "early leavers."
Only on rare occasions did anyone leave the session (for child care). Group sessions were held
with ample time to provide snacks, conduct the session, and hold side discussions with those
unable to fully address an issue – either for fear they would be identified with a particular
response, or who simply had additional information they could not share during the allotted time.
Such sensitive issues included gang-related discussions. It was not uncommon for the team to
stay more than 30 minutes later to gather additional information.

Early in the process, we found that a particular format – a circle - provided the most response
from participants and allowed the moderator to move around freely and engage participants. A
rectangular format did not produce similar findings and seemed to stifle participation. Those
arriving in the designated area formed small discussion groups and waited for instructions. All
attendees had been informed of the reason for their participation, although they did not know the
nature of the planned discussions. Staff made efforts to understand the group’s dynamics to
better promote interaction and open discussions and to generate relevant data for analysis.
Participants introduced themselves to the moderator and to the other group members.

Each session was recorded using audiotapes (at least four per session) to ensure all information
was obtained from various angles in the room. Paper and pencil recording was used in addition
to data recording, allowing staffers to gauge responses, make notations regarding the group’s
reaction to specific issues, and document any characteristics and/or nuances specific to each
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 46

group (body language and non-verbal communication). Participants were encouraged to freely
discuss the issues, and effort was made to ensure that no one person monopolized the discussion.

Interview Activities and Data Collection. The method used for the collection of focus group
data is consistent with verifiable research in the area. The study design was used to help provide
rich description and understanding of issues endemic among Newark residents, and to clarify
views held by residents, providers, policy makers and other key stakeholders about these issues.
Hence, extensive effort was made to guide the data collection process using this format, as well
as the interpretation of data gleaned from these efforts.

Effort was made to focus on the respondents rather than the moderator. Discussions began with
general questions about the specific community in which the session was being held, to enable
the group to describe the area where they live as a mechanism for gaining trust and encouraging
participation. The moderator made eye contact with non-active participants to encourage their
involvement and shifted the discussion to discourage overly verbose participants.

The focus group was initiated after gaining informed consent from the group. Each individual
signed a consent form to secure their participation and another to acknowledge receipt of the
incentive packet. There were at least four observers per session who took paper and pencil notes,
and were instructed to assist in ensuring the flow of discussion. Generally, the flow of
conversation moved evenly around the group, which allowed each participant to express his or
her views and feelings on the issues. When there was potential for disruption, the moderator
would shift her attention to another participant, change the subject, or make a joke to stabilize the
group and refocus the discussion. Observers noted the nuances and specific idiosyncrasies of
each group, and shared that knowledge during a debriefing period.

Throughout the various focus group sessions the moderator summarized the discussions after
each major area was completed, to ensure consistency of information and that discussions were
completed on the specific area of interest. Participants were asked at the end of each session to
provide a verbal assessment of the session, and to offer additional insights as necessary.

Data Analysis. Data from the focus group discussions were analyzed by ward. Qualitative
content analysis was carried out on the notes generated from the field, using paper, pencil and
audiotapes. Research assistants (observers) from Newark DHHS conducted initial transcription
of the notes, and the subsequent transcriptions were completed by analysts trained by the
consulting team. The focus group moderator holds a Doctor of Public Health degree and two
Masters Degrees in the field of socio-medical science and public administration. Newark DHHS
staff who transcribed the notes first reviewed the notes independently to help focus the
discussion on major content areas instead of words or phrases. This also ensured reliability.
Both DHHS staff and researchers reviewed and reached consensus on areas of inconsistency.
PowerPoint presentations were generated from these notes, and were later used as a data source
for the community forums for each ward and presentations to the Planning Partnership.

Focus Group Findings: Results of the Focus Group Discussions
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                            Page 47

Background: The Changing Face of the Newark Neighborhood

In the past decade, Newark has experienced tremendous changes due to the revitalization [or
reinventing] of Newark. The economic development effort has included construction of a super
highway leading to Newark Liberty International Airport, one of the busiest in the nation; an
expansion of the inner city rail system to cover a wider geographic area; completion of the $180
million dollar New Jersey Performing Arts Center (NJPAC) in October 1997; the completion of
the $35-million dollar baseball facility called "The Den" located north of NJPAC; the expansion
of area schools of higher education that collectively now conduct nearly $100 million dollars
annually in research at 14 advanced technology centers; and other construction projects along
Military Park, the Riverfront area and the proposed New Jersey Devils Stadium in the downtown
area. New homes are being constructed throughout many of the city’s neighborhoods.

These efforts were designed to stimulate economic growth and community pride in the post 1967
riot era. However, the intended effects have not fully materialized. In their wake has been a
seeming deterioration of the social fabric of the city, the rise of a large economic underclass
population, an exodus of the middle class to the nearby suburban communities, and an increased
sense of disillusionment among those left behind.

Research indicates that Newark has been - and is - the scene of massive urban change. Experts
contend that such change brings disorganization. The riots of 1967 serve as the backdrop to the
changes in the city, which saw white out-migration and loss of factories that provided jobs to
area residents. According to researchers, in cities with major riots the median black family
income dropped by about 9% from 1960 to 1970, compared to similar cities without severe riots,
and the median value of black-owned homes dropped 14%-20%, compared to cities that
experienced little or no rioting. Further, in such cities, from 1960 to 1980, male employment
dropped four to seven percentage points, compared to similar non-riot cities. The argument is
that riots do damage, and the perceived risk of future riots was concentrated in predominately
black neighborhoods. This background information is relevant because, while the riots occurred
several decades ago, their remnants persist evidenced by lack of economic benefits for the larger
community and social ills observed citywide.

The fact that the benefits of the city’s revitalization efforts have not trickled down to the majority
of its vulnerable residents means a disconnect between measures designed to uplift them and an
unanticipated byproduct of social ills experienced by focus group participants. For example, the
construction of new homes is a significant effort toward increasing homeownership among a
population with little fiscal investment or business equity (two key markers of wealth), which
has translated into seeming exclusion of the city’s most vulnerable and displacement of those for
whom revitalization was meant to reach. The fact that many long-time residents find a gap
between themselves and owners of the newly constructed homes means the effort to improve
neighborhood pride has in itself created a divide. Revitalization projects have not led to
meaningful employment for the city’s poor. Consequently this group is not only unable to
participate in new home ownership but has become a victim of the accompanying demolition and
resulting shortage of affordable housing. Many neighborhoods now have a concentration of
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 48

high-risk populations in one area, exacerbating the frustration felt by these vulnerable
populations and the resulting violence now perpetrated on city streets.

Socio-Demographic Characteristics
Focus group participants ranged in age from 18 to 85. Less than half (43%) or 100 of the 230
participants were male. African Americans contributed the majority of participants, followed by
Hispanics and whites. A small group of Africans and Caribbean Islanders also contributed.
Length of residency in the city ranged from three months to 50 years. Participants were drawn
from all educational backgrounds, from a fourth grade education and those with a college degree.

Status Report on the City
A substantial proportion of focus group participants in all five wards had lived in the city for at
least 10 years. Thus, participants were acutely aware of the environmental and social changes
that have taken place in their immediate community and the city as a whole. Areas of interest
addressed by participants included the sale and use of drugs, gang activities, effects of
neighborhood factors on the population’s health, common health problems, perception of health,
source of care, barriers to care, overall community weaknesses and strengths, and solutions
proposed by participants to help ameliorate life in the city. Participants were asked what they
thought about the city and if in their mind the city has experienced any major changes in the last
10 years. What emerged were varying perceptions regarding these issues by ward of residence,
gender, race and age. Often, when a common issue was discussed, participants from the same
age and racial group offered varied perspectives based on their area of residence. This made
geographic boundaries a relevant factor in the findings of this study as shown below.

Community Concerns
A number of social issues were of grave concern to focus group participants across all wards.
These included crime (quality-of-life and violent crimes), police harassment, gang activities,
housing conditions, and youth behavior. The consensus among participants is that Newark was
unsafe. “It’s dangerous out here,” noted one youth from the Central Ward, rousing a unanimous
nod from the group. This represented the sentiment of almost all focus group participants,
including adults and elderly. In a West Ward group, a youth reported, “I’m about to leave
Jersey. I can’t take it any more.” Others felt the need to protect themselves in the wake of the
never-ending violence. One noted, “All this violence makes me feel like staying safe, and
protecting myself.” This perception about the community in which they live drives most of their
everyday decisions, and may help explain the both relationship between police departments
across the city and the various communities they serve and some of the health problems of
participants. Per the quantitative study, 25% of youth had experienced threats or injuries related
to weapon use, 41% reported involvement in a physical fight, and 15% felt the need to carry a
weapon for self defense as a result of their experience in a fight.

Data gleaned from focus group discussions revealed that youths were concerned about rape,
gangs, and the violence in Newark streets. The need to leave was pervasive among focus group
participants, many of whom could no longer deal with the excessive violence and the heightened
stress level that was now a common, everyday occurrence. However, a closer look at these
issues provides some understanding of participants’ views and general concerns.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 49

Crime and the Community. Crime was a major social concern among focus group participants.
The major quality-of-life crimes noted were motor vehicle thefts and reckless driving. Violent
crimes included shootings, killings, and other gang-related activities.

Motor vehicle theft was a major community problem across all wards. We were informed that
these crimes were perpetrated both by young people and adults. In the South Ward, participants
expressed concern about the high rate of crimes, and the fact that, “Grown men were stealing
cars.” In many wards, participants were concerned about safety and the increased risk of
accidents associated with stolen cars. They noted that drivers of stolen cars often rode around
their neighborhoods at high speeds that at times instigated police chases. Many expressed the
need for speed bumps to curb reckless driving associated with stolen cars. One participant from
the North Ward noted, “I live by a school. There are no speed bumps for traffic passing the
school and people drive fast, putting peoples lives at risk. I am afraid for the children as well.”

Among participants from the West Ward, motor vehicle thefts posed an added problem, namely
high car insurance rates. Participants indicated that the spiraling cost of auto insurance was a
direct result of the neighborhood high car theft rate. For small business owners such as taxi
drivers - whose livelihoods are dependent on car transportation services – it is an especially
difficult issue to deal with. They felt that insurance companies were targeting high-crime urban
areas such as Newark for high insurance premiums, to offset the high cost of potential losses due
to vandalism, accidents and theft. These problems, they noted, are endemic to Newark.

Among taxi drivers, earning a decent wage now required more investment in time and energy.
Taxi companies in the West Ward are major employers among some populations including
Haitians. This source of employment allows many to avoid using public assistance. Because
lack of job opportunities was a common problem across the various communities, any effort to
thwart employers’ ability to offer jobs has the potential to aggravate the economic hardship
experienced by many of the city’s poor residents. We were informed that many drivers must
also deal with the high cost of gasoline. Because they must lease these vehicles and then provide
their owners with a minimum of $350 per day, regardless of earned income for that day, high
insurance premiums impact their daily earnings.

In 2004 there were a total of 5,859 reported motor vehicle thefts in Newark (2004 Uniform
Crime Report- New Jersey). This translates to 2108.2 per 100,000 population, which is nearly
four times the national rate of 526/100,000, and nearly six times the state rate of 348.9/100,000.

Newark also reports a disproportionate share of violent crimes. The murder rate for the city in
2004 was 30.9 per 100,000 population. In 2005, the city was ranked 14th nationally in murder
rate, after Washington D.C., which ranked 13th. The corresponding figures were 4.5 for the
state, and 6.9 for the U.S. as a whole. In fact, of the 392 murders reported in the state in 2004,
21.9% (n=86) occurred in Newark. Murder was eight times more likely to be reported in
Newark than in the state as a whole, and five times more likely to occur in the city than
elsewhere in the nation. According to more recent statistics, however, the number of murders in
Newark has increased to 100 reported incidents this year alone (Star Ledger, December 2006).
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 50

Further, in 2004, the overall Crime Index in the city was 5,529.4 per 100,000 people, compared
to 4629.7/100,000 reported nationally. Thus it was no surprise that focus group participants
considered violent crime an overarching issue in the city.

Focus group discussions revealed that many participants had been victims of mugging, and many
had been exposed to other violent crimes. The pervasiveness of exposure to violent crimes made
many youths and adults fearful of going out at night or after certain hours because it was
considered dangerous. The fact that many young people are now hanging out on street corners
with nowhere to go and nothing constructive to do, means that area residents had to devise
alternative lifestyles. Many are now staying indoors to stay safe, such that neighborhood safety
has become a top priority.

One South Ward participant noted that gang members were frequently engaged in physical fights
in front of her home, often resulting in shootings and ensuing police chases to get the
perpetrators. Another participant noted you cannot go outside to get a quick snack, for fear that
someone will knock you in the head en route. All participants agreed that things have gotten
worse. Elderly participants from the South Ward group felt that the upsurge in street violence is
associated with an increase in drug dealing and gang activity. They blamed these social crimes
on the lack of prayer in schools, with residents having no regard for each other.

West Ward participants also noted gang activities often resulted in gunfire between police and
gang members, with subsequent chases going on for hours at a time. These activities often
disrupted family life. For many residents, the constant exposure to gunshots had prompted them
to consider leaving the city to provide their children the best possible chance in life.

Central Ward participants found the persistently high rate of violent crime alarming, and
associated these crimes with the rise in drug sales, drug use, and the involvement in gangs in
these activities. They noted that current efforts by the city government to address crime seemed
futile at best. An elderly resident had been robbed several times for their Social Security check.
Another had moved back in 2003 and had been robbed three times, with sometimes the police
taking three to four hours to respond.

Gang Activities. The pervasive problem of gang violence has had a paralyzing effect on
neighborhoods across the city. The fact that residents, particularly mothers and young people,
felt that death was imminent and growing into adulthood was a luxury, meant that planning for
the future was almost non-existent. This means achieving academic success, a prerequisite for a
stable life and rewarding career, was rarely considered among many of the families in our study.
But this lack of planning perpetuates the cycle of poverty, because many have low literacy
levels, are unemployed, and at risk of joining gangs. The streets were considered the only outlet
for many young people, and those who chose an alternative lifestyle are forced to stay indoors.
Fears were consistent across all city wards. A Hispanic mother in the North Ward said that the
neighborhood is so bad that all you want to do is get into the house, where you will be fine. A
mother in South Ward noted that she was afraid she will not see her grandchildren grow up.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 51

Many of these individuals have given up on their community and have found alternatives to
outdoor activities, including free movies. They felt the parks were dirty and unsafe and no place
to take young children. Staying indoors was common. One African American male in the
Central Ward noted that they were afraid to come out of the house to use needed resources
because of the young people. His mother has bars all around her house. The elderly noted it was
not uncommon to hear bullets outside, and are accustomed to hearing gunshots in the community
from increased gang activities and the resulting turf wars. Those who venture outside of their
homes, in spite of the these challenges, do so because they refuse to be prisoners in their own
homes (South Ward elderly) or because they took their “God” with them wherever they went.

Drug Use and Sale. Participants spoke about the changing face of the community in terms of
increased prevalence of drug use. Many who had seen a decline in drug activities with the
emergence of HIV/AIDS in the 1980s and early 1990s were now concerned about the resurgence
of drug activities and the heightened negative social fallout. Participants discussed the fact that
many drug abusers who had “gotten clean” were now using again, and the social cost is far more
pronounced. Not only are these “old timers” using again, the new groups now included youths,
women, and the elderly. In many wards, women in their 30s, 40s and 50s were drug abusers;
some indicated their attempt to quit and the fact that they are tired of using drugs.

Many participants used drugs to feel good and to avoid experiencing any type of pain. This
made it easier to bear the pressures in the household and community. The feeling derived from
drug use was eloquently noted by one African American male participant in the Central Ward:
“Well, we all know about heroin, cocaine, valium…I ain’t gonna front (i.e., pretend) like I don’t
know. Those drugs might mess you up physically, but mentally they make you feel good.” This
feeling was echoed across the room and attention focused on his use of the word “good” which
emphasized his point. The statement generated widespread laughter and agreement from other
participants. Another indicated drug use allowed them to do things they would not normally do.
There was no consensus as to whether this was good or bad for the user. Rather, as one noted,
“Man, that heroin will make you walk to North Dakota.”

The indication was that participants often used negative coping mechanisms to help deal with
issues facing them. This made drug use possible. Still others talked about weight loss associated
with drug use, due to loss of appetite. Some agreed that weight loss was a positive benefit of
drug use, while others noted that a severe negative effect on the body. In neighborhoods across
the city many residents were exposed to excessive drug use including heroin, sticks, weed,
valium, Percocet, Xanax, cocaine, and others. These drugs, they noted, break down the body’s
immune system, although they offer a false sense of mental uplifts. One participant noted, “It
lifts up my mental spirit. And, I kinda like it.” Although some argued that drug use negatively
impacted the ability to make effective decisions and often made them feel sick, others said it was
the perfect escape from their life situations.

Drug abuse was cited by African American females in the South Ward as a common health
problem. Many had used drugs for 10 years or more and had used every drug possible, including
heroin, cocaine, crack, marijuana, and legal drugs. They noted that the elderly snorted Pam spray
on cloth to get high. Other “drugs” included hairspray, paint thinner, glue, nail polish remover,
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 52

and formaldehyde. Some used drugs to make them feel calm, avoid hurting themselves, forget
things they did not want to think about, or as a salve for emotional issues that span their lives
including childhood (e.g., gang rape at age 12, loss of a son, likely cancer diagnosis). Many had
been introduced to drugs by friends, family members, the streets, or co-workers, many of whom
were professionals and functional users. Many started drug use at an early age (11 to 17) and
progressed to more hardcore drugs later in life. One participant started free-basing at age 45.

Many said they had mental health problems and had experienced depression and post-traumatic
stress disorder as well. One used drugs to stop from missing her murdered kids; another said she
had been taken to the morgue to identify her murdered boyfriend’s body. Many cited tragedies
that had overwhelmed them, including incest at very young age and physical abuse. One had
been raped by her brother and father, but her mother had asked her - not her father or brother - to
leave the house and family. Another had had two children by her own father at age 12 and age
14 (began molesting her at age two with sexual penetration at age 10). She noted that the laws
governing incest had changed from her situation in the 1960’s when she was told that she was
crazy. Others reported abuse by husbands that included the children. Many participants had
other heart-wrenching stories that helped explain their drug addiction. She and the others had to
deal with these issues throughout their lives. Many had blocked these traumas, but were now
often confronted with the pain. Nine of the 11 participants said they had used drugs.

Drug activities occurred in various venues throughout the city, e.g., public housing units or on
the streets. In one public housing complex in the East Ward, residents were concerned that drug
paraphernalia were thrown casually in their neighborhoods and were picked up by children.
Within public housing, it was not uncommon to find the elderly using drugs. The fallout of drug
use was similar regardless of location – factors of concentrated poverty and a culture of perpetual
social ills such as unemployment, welfare dependency, and incarceration. Drug use and sale in
these areas are considered part of normal everyday activity. Some are drawn into use, others
condone sale by family members, and still others view easy access of drugs as a normal part of
their daily lives. “Children walk around with $3,000 on them and their parents claim they did
not know that their kids were selling drugs.” The concern was that drug use among area
residents was now a public activity, one that was no longer confined to the home environment.

Other Factors in Drug Use. Many substance abusers indicated they had made efforts to quit.
But the effort to get clean is often thwarted by the increased awareness and diagnosis of health
problems that may have been dormant, ignored and are now emerging. This was of increasing
concern to many across all wards. Now they have to deal with cancer, diabetes, etc., have
surgery and may not be able to afford needed medications. The realization that they now must
adopt appropriate health-seeking behavior to address their health problems raises another set of
issues. Many may have to obtain health insurance, e.g., Medicaid, but may be ineligible due to
prior incarceration or may not have easy access to or be welcome at social services offices. If
they go without insurance, their only source of health care becomes the area emergency rooms.
If they obtain insurance, they have to find a doctor that will accept it. Many do not know the
benefits they are entitled to, such as transportation assistance. They may present for care
indicating no health insurance to avoid answering questions that would expose their past or lack
of knowledge. The problem of social distance between these vulnerable health care consumers
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 53

and providers complicates the need to seek health care. These factors may be too overwhelming,
so they often revert to drug use to forget they ever had a health problem. This compounds the
city’s problem. Drug relapse weakens already vulnerable families, causing many children to end
up in the foster care system. Parental drug use impacts children’s academic performance and
school attendance, and diminishes any sense of hope they may have for the future. These parents
are role models to their children, and what is not learned at home is picked up on the streets, a
daunting prospect for many area residents and policy makers.

Not only does violence accompany drug use and sale but so does an increase in prostitution. In
the East, South and West Wards participants expressed concerns regarding this issue. Youths in
the East Ward could find visible prostitution on one street or neighborhoods but not in the next.
In the South Ward, African American male and female participants considered prostitution a
major environmental and health hazard. One public housing unit that initially housed only the
elderly was now overrun by a much younger population of individuals that included the disabled,
ex-convicts, and derelicts. Many live in this unit illegally, because of the demolition of their
public housing units for new home construction. Many were released from jail and sent to this
public housing unit. One African American male participant came from Atlantic City jail and
never expected to be put into a senior citizen high-rise. Elderly and disabled residents feel they
do not have promised 24-hour security. They noted that other [elderly] residents let people into
the complex to use the bathroom, have sex in the hallways, and get high. Hookers can be seen
on the street, and they pay an elderly resident a small amount of money, who then allow them to
come into the building to wash up. Some of the elderly are now using drugs or are customers of
the prostitutes. Others are concerned about HIV/AIDS and getting it from the bathrooms which
are not cleaned. Another participant said that her husband threw her out of the house because
she was involved in prostitution. She had nowhere to go, and was placed in the senior building.

Crime and the Police Department. The outcome of the high crime rate in the city includes a
changing law enforcement culture that seemingly targets everyone, including innocent residents,
as part of a strategy to minimize criminal activity. Many feel disenfranchised and vulnerable to
police abuse. Police harassment is an ever-increasing problem associated with the neighborhood
factors. Thus many – all racial and age groups - feel a sense of helplessness even in light of
visible police presence in their community.

One Central Ward resident, an African, was stabbed two years ago and was a victim, but now
feels victimized due to the perception that police abuse many foreigners/immigrants. Police
harassment toward immigrants is also seen in the ticketing of improperly parked cars noted by
one Haitian in the West Ward. Paying the cost of three parking tickets meant he could not take
his sick wife to the doctor. The perception among these Haitian immigrants is that police
officers and the larger court system take advantage of cab drivers to make money. If they had
been true African Americans, they feel they would not have gotten the tickets. A Caribbean
Islander stated he had been a victim of police harassment but “had to use his influence” (drop
names) to get out of the situations.

In the South Ward there were concerns about police involvement with perpetrators – they felt
they were “shaking hands with dealers, and locking up the innocent people.” But another said
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Summary: Community Themes and Strengths Assessment                                         Page 54

that the police are cracking down more, and have been clearing the front of the building. These
participants have observed increased police presence in areas considered rough spots.

Many in the Central Ward also considered police harassment an ever-present problem. They
noted frequent police chases and the fact that police officers do not respect community residents,
as guns are often pulled in full view of young children. Hispanics in the Central Ward cited
extensive drug activity in their community and noted area residents spend too much time waiting
for the police to show up at a crime scene. They felt that the police will only come sooner if they
are told a person has been hurt or shot. Lack of police presence concerned the elderly in the
Central Ward area, who felt there were more police the street because it was election time.

In the East Ward, African American female participants talked about difficulty reaching the
police department and getting them to respond immediately to an urgent call for assistance.
However, this group’s responses reflected a lack of knowledge about how the emergency
response system works and what needs to be done to get such assistance (information about
victim and situation). Nevertheless, slow police reaction time was of grave concern. Others
noted that response time was very quick depending on the reason. Youths in the East Ward said
that loitering was more likely to generate an immediate police reaction than someone being hurt.
Police are more visible when ticketing illegally parked cars than when called for emergencies.

In general, participants would prefer to see more police on their streets. A Central Ward elderly
participant stated that security is needed, especially when we go to pick up our checks. Others
thought that local businesses should contribute to security in their neighborhoods. One individual
from the Central Ward articulated the violence issue: “From Spruce Street, to High Street, to
Martin Luther Kind Boulevard, to Avon, to South 14th Street and to Irvine Turner Boulevard,
that’s the corridor plagued by violence. Since I moved here six years ago, there have been 22
shootings and murders at a particular phone booth, located at the corner of Spruce and High
Street. The last murder involved a 17-year-old boy.”

The feeling was that police officers who worked in the area did nothing to improve security
because they are part of the problem. Some (South Ward) felt police presence was more of a
detriment than a benefit to the neighborhood, particularly when the lack of recreational activities
was discussed. Participants said that children were unable to go outside to play double-Dutch, as
in earlier times. But when asked if such activities could be arranged with police supervision, the
unanimous response was that no one would come out to play if they saw police officers in the
area. Lack of trust of the police was at the center of the rejection of police involvement in
community affairs. While one community complained of lack of visible police presence and
slow response time, another felt unsafe even with highly visible police officers. One participant
stated that helicopters flying around the area irritate the community. Many want to get out of the
area and go anywhere other than where they are now. Concerns about the police department
were also echoed by youth in the East Ward, who considered the police corrupt and uninvolved.
Others thought that the police simply were afraid to venture into the community to offer any type
of assistance. Lack of a visible police presence in their neighborhoods was a concern, noting that
most police congregate on Ferry Street. One participant said there were three muggings on her
street in one week, and there were no police officers around to help these victims.
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Summary: Community Themes and Strengths Assessment                                          Page 55

In the North Ward it was not uncommon for participants to consider the police part of the city’s
problem rather than a resource. One participant noted that gangs are a big problem in our area
(admittedly, parents need parenting skills training.) However, police themselves seem to be a
part of the gang called Bloods. In my building, we have 24-hour security, but the police watch
out for the dealers. As a recovering addict, this environment is not good for me. We need to
take back our neighborhood from the dealers and gangs.” It is unclear if the “police” were
security guards or police officers moonlighting as guards. Nonetheless, one participant summed
up the issue, “I want to be able to walk from my home to the store and back in safety. That’s all.”

Other Concerns

Participants were concerned about their physical environment and the manner in which the city
handled waste, including animal waste, which many consider a health hazard. This problem
impacts the quality of life of residents, who view it as a lack of respect on the part of the city
government towards the well-being of its residents.

The high crime nature of the area also affects access to basic services. Focus group participants
in the West Ward underscored this point, citing long waiting times for phone installation and
repairs by the phone and public service companies as a result of the largely minority-populated,
crime- and poverty-ridden environment in which they live. As one respondent put it, “It takes
weeks for the phone company to come and fix things because we live in Newark. I want to move
from this area. We get poor service because we are living in Newark and we are black.”

The perceived inappropriate use of funds directed at Newark is also a concern to area residents.
The point was made that the constant violence has given rise to the development of a trauma
center in the city. The Level 1 trauma center deals primarily with gunshot and stab wounds.
This means that the bulk of the health care resources allocated to the city go to the trauma center.
The priority afforded this area of care means very little funding is left for other programs,
including those that address chronic diseases that plague city residents.

Participants were also concerned about the pervasive issue of homelessness. One commented, “I
see a lot of sick and homeless people, and drug dealing in the community.” Participants felt this
problem was in some ways associated with the failing school system and lack of parental
involvement resulting in truancy and drop outs. They noted the consequences of school drop-
out, including teenage pregnancy, high rate of sexually transmitted diseases, unemployment,
gang involvement, continued cycle of poverty, high crime rate, and other social ills.

The cost of renting in the city has gone up astronomically and many vulnerable populations
cannot afford housing, making life more difficult for Newark’s poor residents. One participant
has been living in the shelters for awhile with her five children while awaiting Section 8 housing.
Since many are eligible for Section 8, the wait for a housing unit may be more than three years.
Her children were not attending school during this waiting period and instead they were doing
what she called “rippin” and “robbin” (i.e., sex and mugging) because they had nothing else to
do. Another participant chimed in, saying, “These kids have no home training, no community
services to go to, and Boys & Girls Club has a limit on how many children they can take.”
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Summary: Community Themes and Strengths Assessment                                          Page 56

One participant from the North Ward expanded on the impact of homelessness on children. Her
17-year-old son had recently been admitted into Johns Hopkins University in Maryland, but he
was concerned about going away to school. He had never traveled beyond his immediate
environment and was afraid of being left there unaccompanied. He had not lived in a structured
environment in a long time, had poor grooming habits, lacked knowledge about proper etiquette,
had problems dealing with conflict, had an anger management issues, low self-esteem, and was
worried about the perception of others. She had attended college for two years, but had been
introduced to drugs by friends and had spiraled downwards since then. She is due for Section 8
housing in a few months and is unsure how the children will adjust to a lifestyle to which they
are unaccustomed. The fact that they would have their own rooms and be able to lock the door if
they choose was somewhat of a concern. At the time of the discussion they were sharing a room
with five other families and were not allowed to lock the doors, for safety and drug use concerns.

Poor housing was also a concern in the East and South wards. Many have no heat in their
homes, hallways littered with drug paraphernalia, mold on their walls and insect infestations,
including bed bugs, roaches and rats, which put them at risk for poor physical health. Some
reported peeling lead paint in homes that had young children and lack of running water for the
shower. They felt they had been abandoned by both their landlords and city government. The
inability of housing officials to require landlords to take proper care of their buildings sent the
message that they were not considered a relevant part of the community. Participants indicated
that they would like to see their councilmen, including those at-large, in their community. They
feel they are not being represented at City Hall by the current City Council. Others noted that
their community must take an active role in community politics and events and participate more
in the political process. Others thought they were being helpful by leaving the area in a belief
that doing so would reduce the crime level. At least they will not be added to the crime statistics.
Central Ward residents felt many of their buildings were dilapidated and an eye-sore.

Youths in South Ward noted that the high cost of rent was a hindrance to comfortable living.
Not only were affordable units being demolished, but the city was putting up new construction
whose price was out of reach of most area residents ($1,300-$1,600 per month). These structures
were being built at very fast pace with no contribution from members of the community. Their
presence has not resulted in jobs for area residents. Those whose buildings were demolished
must go elsewhere because the new units were unaffordable. In some communities these
individuals are now concentrated in small quarters, which has aggravated the crime, drug, and
gang problems. One participant stated, “Our jails are overflowing with people committing
crimes that could have been prevented.” At least half of the African American (male and female)
participants – and as many as two-thirds in some groups - had been incarcerated at some time.

Seniors in the East and West wards expressed concern about the lack of easy access to
transportation services which were in short supply for this population. In the Central Ward,
elderly participants were concerned about the distance to the post office, fearing they would
become crime victims while traveling. These seniors feared venturing outside in the evening
because they would often fall prey to muggings. Many had also witnessed drive-by-shootings.
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Summary: Community Themes and Strengths Assessment                                          Page 57

We were also informed that many seniors lack financial resources to meet their basic food needs.
In the East Ward, e.g., malnutrition was an emerging problem, with some seniors starving and
becoming dehydrated since they had no money to buy meals. Many seniors also lived alone,
making access to area resources difficult. This increased their risk of starvation and
noncompliance with medication due to inability to get to the pharmacy to pick up medications.

Also in the East Ward noise pollution was considered a major problem by the elderly. This was
mainly a result of airplanes flying over the area, producing noise that many called irritating, loud
and startling. The seniors also noted problems with the incinerator on Hawkins Street which
they felt added to air pollution. They were also concerned about environmental conditions, such
as dirty streets. They talked about the inability of homeowners to clean snow and properly store
their garbage, which they said increased the number of rodents in their neighborhoods. The
indication was that the increase in illegal immigrants who now overpopulated their
neighborhoods resulted in overcrowding in the homes and increased garbage dumping.

Youth and elderly in the East Ward were equally concerned about people hanging out on street
corners, making life outside uncomfortable. One participant would cross the streets if he saw a
group of young people congregated in one area – for fear of being mugged or attacked. The fact
that children and youth must stay indoors was in part due to the lack of open space in their
immediate surroundings. Youth blamed this problem on widespread housing construction that
did not consider lifestyles of young people. There are no manicured lawns and insufficient
parking for area residents.

Both youth and the elderly noted that the influx of new residents had increased the area’s rental
cost, which then led to overcrowded conditions since residents “double up” to more easily afford
their rent. Overcrowded housing also meant overcrowded, poorly maintained area schools that
are no longer conducive for children. These two population groups were equally concerned
about the lack of traffic lights in certain areas, and the increased risk of accidents as a result.

In the Central Ward, African American males were concerned about the push to close down a
local pharmacy, which was critical in the community for access to prescription drugs for the
elderly and for those without transportation to more distant pharmacies. Seniors were concerned
about the inadequacies of most area pharmacies. Some were unable to get their blood pressure
medication for several days from the local Rite Aid pharmacy, since it was out of stock. Many
had already changed their social lives because their medication came first; delay in getting
needed medication was of a particular concern.

The lack of after-school programs was also of concern to residents of all five wards. Many lack
basic information about available resources, including the location of area kindergarten programs
– particularly the Portuguese, Brazilian and Hispanic immigrant populations in East Ward. In
other wards, the issue was the inadequacy or shortage of such programs. Hence children were
forced to stay home. Many need babysitters to take care of their children so they can go to work.

Participants were concerned that area residents were not protecting themselves, given the high
rate of STDs in their neighborhoods. One participant commented, “I don’t like being alone. So I
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 58

use a condom.” Others were concerned about chronic health problems now common in the black
community, including diabetes; breast, colon, and prostate cancer; and high cholesterol. Poor
food habits of many area residents which increased their risk of certain health problems was also
of concern. Many ate mainly fried chicken and fast food, with little water or vegetables in their
diet, and no one to reinforce good eating habits. African American females were concerned
about the lack of jobs for young people, shortage of constructive activities and earning money.

All participants were concerned about not having a safe haven for youth in their communities.
Youth were also concerned about lack of money and job opportunities. They were unsure about
the future, and many had no future plans. They were afraid they would be killed and not grow
up. Those with children were even more concerned. Some said their children wanted to grow up
too fast. The children have problems and had no way of dealing with them, since they had no
support system to provide any type of assistance.

In a bid to improve their community, many youths noted that they were staying in school,
mentoring younger children and assisting them with money if they needed help. Some did not
want the younger children to do what they were doing, so they provided advice and alternatives.
One stated, “My little brother, who was eight years old, rolled up a piece of paper acting like he
was smoking. I had to tell him about the disadvantages, and talked to him about other things.
That’s the best I can do to help. Just pass on important information.” Others said they would like
to start a security team to patrol the streets. Still others would coach a ball team.

Causes of Community Decay
Participants considered some root causes of the city’s problems to be lack of youth recreational
programs or places for young people to go for assistance or to engage in meaningful activities;
lack of parental supervision and attention causing young children to grow up too fast; children
staying indoors and watching too much television; peer pressure; and the failing school system.

Across all wards the lack of after-school programs for children was considered a central issue in
the city’s current social crisis. There were no facilities for children to release pent-up energy or
to provide tutorial services, and no place for parents who are afraid to send their children outside
to play to go with their children. The absence of these facilities was felt to have far-reaching
consequences – with children unable to navigate their physical environment, unable to negotiate
social relationships, and unable to develop positive coping skills particularly with their peers. In
the South Ward, youths must venture outside of their own neighborhoods to find recreational
activities. They would often go to Central Ward to locate free and accessible basketball courts.
The lack of recreation programs for children, including those that require adult accompaniment,
means negative social behaviors are learned early on, with little intervention from caring adults.

Another problem is the home environment from which a substantial proportion of the city’s
children come. Many children, we were told, were from homes in which parents themselves use
drugs. This means lack of parental supervision, proper nurturing, and poor nutritional health.
Many eat junk food because they are rarely given nutritious home-cooked meals.
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Summary: Community Themes and Strengths Assessment                                        Page 59

The elderly were concerned about the lack of a male role model in many households. The
children needed a father at home to provide guidance and direction, and seldom is there one.
When asked if fathers were involved in the lives of their children, one female South Ward
participant responded, “We are the fathers. You are looking at them. He’s here. He’s a good
one.” She pointed to another female in the group, who then stated, “I put the kids in check. I’m
not playing with them, I’m not their age.”

To underscore this problem, African American males in the South Ward told us that some
parents these days are getting high with their kids. These parents were raising their kids to show
no emotion; hence they were being raised and guided by the streets. They saw no hope for many
of them. “There is no one to sit down with them, one on one, to get into their heads to help. But
then again, one cannot help unless the youths themselves want to be helped.” Another suggested
that since many end up in jail, a pen pal approach that continues long after they have been
released might help them transition into the larger society.

There is also the issue of poor parenting for those who have at least one parent at home. There
are an increased number of parents who are on drugs, high school dropouts, unemployed, or on
welfare. There is also the issue of “babies having babies.” The outcome of these parental
problems includes poorly trained, unsupervised and unfocused children with no sense of purpose.
These children lack home training. As one participant stated, “I saw a parent cursing out her kids
like sailors do. When these children get older, they are likely to treat their children in that
manner, thinking it is acceptable behavior. They’ll think it is okay to curse. The reason is that
children are having children and are doing so at a very young age. Also, they get pregnant and
are not interested in school. So you perpetuate the problem of illiteracy, unemployment, and
welfare dependency that now overwhelmed our neighborhoods.”

A lack of jobs for youth results in idleness and boredom. Young people are at risk of teenage
pregnancy, since they are more interested in being out on the street than in school. Others blame
easy access to welfare as a root cause of the community’s problems. “The government offers too
much assistance to people who choose not to work. There is a need for more jobs.” “The work
ethic of old no longer exists in today’s society, more specifically in the younger generation.”
“These young folks are not willing to work for minimum wage. But we worked for less. We tell
our kids that we want better for them. That messes them up because they are not encouraged to
start at the basic level - working and learning what it means to earn money the right way. Our
communities now have businesses owned by people from other cultures, like the Hispanics and
Arabs. No black businesses anymore because our children are not willing to work or put in the
time to learn how to earn a dollar.”

The failing education system was another factor blamed for the social ills in Newark. The
importance of education is being minimized by both the formal system (teachers and DYFS) and
the informal (parents). The key to addressing many of these social ills is to strengthen the
educational system. Parents are not available to help guide their children through the school
system because they too lack the skills to adequately offer any meaningful assistance. Parents
themselves were hardly around to provide guidance and direction. And teachers are not allowed
to even chastise children anymore because they are afraid of the consequences. The end result is
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 60

undisciplined children who lack home training, and who cannot get the help they need from
teachers who could have served as a safety net for the shortcomings of parents. As a result, kids
stand on street corners using inappropriate language. They are insensitive to other residents, and
gun violence becomes a common, everyday occurrence. These children stay up all night selling
drugs. “My parents were strict. You go to school, do your homework, and go to bed.”

Because young people lack a father figure in the household, they grow up too fast, smoke, do
drugs, have sex, steal, and succumb to violence. Among 12 teenagers in one of our focus group
sessions, six smoked cigarettes, three drank alcohol and seven used marijuana. The youths talked
about the common use of Ecstasy, which starts early. Participants talked about the lack of family
activities to get parents more involved in their children’s lives, and the need for meaningful
dialogue between children and parents to stem the rising tide of violence in the community.

Other participants blamed many of the social ills on peer pressure. “They are teaching the little
ones the gang signs and slang. They don’t want to join but they feel like they don’t have a
choice. If they don’t want to get picked on and called certain names, then they have to join.”

There were also fears of sexual abuse, which puts children at risk for many social and health
problems. Many of the young girls have fully developed bodies by age 13. They are attracting
older men and drug dealers who consider them mature and ready for sexual relationships. Many
of these girls run errands for drug dealers and are paid for their efforts. They are given money
that they may otherwise not have, and this increases their risk of involvement in a wide range of
unacceptable social behavior.

In the North Ward we were told there is the added problem of men and teenagers being “on the
down low” (i.e., closet gays). This creates many problems for young girls, most of whom need
love. Exposure to these men increases the risk of these young individuals’ contracting STDs and
HIV/AIDS. Many are poking holes in condoms so that they can have their own children to love.
The lack of a strong informal support networks to help guide their social decisions may account
for the rise in this behavior. As one participant stated, “They need God, friends, family, and their
mothers. No one, it seems, is there to offer much-needed help.”

In the East and South wards, youths talked about the deceptive appearance of their
neighborhoods. The congested row of houses, while appealing to the eye, adds to their social
problems as they allow little open space for the children to play. The youth talked about leaving
the area and finding a good community in which to raise their own children, where children
could attend a good school and have access to clean parks. For fun, many stay indoors where
they feel safe, write poetry, watch television, eat, sleep, talk on the phone, or engage in sexual
activity. Their parents were often home or arrived home two to three hours after they got out of
school. Others rarely saw their parents, because some worked two or three jobs which allowed
little time for family. The absence of a parent at home gave these youths a false sense of
adulthood. When her parent is not at home, one young woman said, “I feel grown, because there
are no rules and nothing to do, no parent around to find things for you to do. You feel relieved
because you are not aggravated as you would be when parents are at home. When they are
home, they say ‘do this and do that.’ You feel stressed out.” A majority of the children lived
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Summary: Community Themes and Strengths Assessment                                          Page 61

with only one parent in the household, although some saw the other parent often while others did
so occasionally. Three of the youths, including two with fathers and one with a mother, did not
want to see their parents. Many lived with grandparents who owned heir own homes.

Because there was little or no parental supervision, some of the girls were worse than the boys.
One participant stated, “Because these girls want to ride around in fancy cars, it’s easy to get
them.” But many of those with nice cars are the ones who are killing each other. One participant
noted that he had seen three killings in the previous three months.

The youth also indicated that the lack of negotiation skills and anger management skills made it
easier for young people to get into trouble. Because they lack the mental maturity to go without
things they want – like a nice pair of shoes – they were more likely to feel jealous or angry. So
they are prone to irrational choices like resorting to drugs or violence to obtain the things others
have. It is easy for young people to say “why should I get involved in school and sports, when I
can earn $100 a day?” The access to quick money enables them to get the things they cannot
afford at home and the ability to brag to their peers. They have learned to be disrespectful, and
because of low self-esteem, it is easy for them to feel disrespected. This leads to frequent fights.
Many also have no emotional outlet or anyone to talk to, so they internalize their feelings.

Many youth lack appropriate skills and knowledge to deal with negative situations, so they react
to problems with violence. The sign is that they feel they have the right to take a life. They are
also unlikely to accept help, which makes changing their mind set even more difficult. More
importantly, they lack activities that teach socialization skills, like those commonly available in
suburban communities. Others like to be in control and think it is cool to belong to a gang. They
noted that young people need guidance, because many parents do a poor job of raising their
children. They all know someone who is on drugs, namely marijuana, dope, Ecstasy or alcohol.
They said that drugs shorten lifespan and influences children to have sex early. And they were
concerned that people on drugs get angry easily.

Lack of employment opportunities for youth was considered an important issue that exacerbates
the community problem. As one senior noted, “What’s going to happen when kids have no jobs?
They hang around on the corner.” Another attributed problems to the lack of good education.
They associated the rising crime rate with the lack of recreational programs, including swimming
programs, softball teams, etc. One senior commented that youths have taken over the streets, and
that the seniors are not allowed to wear certain colors if they want to live.

Community Strengths

Focus group participants highlighted the strengths or positive aspects of their neighborhoods and
the city as a whole. Central Ward residents enjoyed the close proximity to area institutions of
higher learning. The college-town atmosphere of Newark afforded interaction with people from
all walks of life. This setting allowed many to feel a sense of pride in their community. They
considered themselves part of something “big,” even though they could see poverty and its
attendant effects all around them. They were concerned that the policy makers were not doing
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Summary: Community Themes and Strengths Assessment                                        Page 62

enough to help the masses. The poor quality of the educational system, in what they consider a
college town, seemed unacceptable to them.

Central Ward Hispanic participants took pride in the fact their streets are cleaned regularly,
indicating a strong community that cares. They gained a sense of comfort from the proximity to
a number of hospitals, which they considered vital to the community’s strength. They were also
linked to community-based services that offered job training and English as a Second Language.

Seniors in the Central and South ward areas said life was made bearable by community centers
that offered opportunities for area residents to interact with each other. These facilities, which
include community centers for the elderly, churches, and recreational centers, were a source of
strength for the communities. Central Ward participants also liked convenient access to
shopping and an extensive and accessible transportation system. Some also reported having
“good” neighborhood watch programs. Availability of fun activities that include bingo,
dominoes, and movies was a plus. Many were also happy that they have a nice place to live.

Other participants cited resources that have been useful to them. These included churches,
recreational programs, shelters, food pantries, and transitional housing. Youth in South Ward
talked about the fact that they have friends and family around that provided some level of
support. “I love my community because everyone knows who I am. This gives you comfort.”

Others from this area talked about community-based providers who offer health education and
distribute condoms widely. Users of these facilities may come from as far away as Elizabeth
Avenue and the Ludlow Street area to Clinton Avenue, where these facilities are located. Others
talked about community health centers in their neighborhoods, but said many are afraid to use
them until they get old and are unable to travel to outlying communities for health care.

Youth also talked about going to buffet restaurants, movies, skating rinks, and bowling alleys.
Many have talents that can be harnessed and encouraged. Annual music competitions, for
example, provide a creative outlet that many desperately need.

Some neighborhoods have community watch and block associations, which provide a safe
environment. Many like the fact that new houses are being built, giving the community an up-to-
date look. Participants reported having easy access to public transportation, making commuting
easy for residents able to utilize it.

Hispanic participants in the East Ward considered community-based programs that provide job
training and teach English as a Second language to be valuable resources. For Hispanics and
Portuguese, having many people in their neighborhoods who speak their language was an
advantage. They enjoyed that they could interact with people from their own cultures, and said
doing so provided a source of emotional support. They are able to obtain child care assistance
from members of their own cultural groups and an increased ability to gain information about
area resources, including taxes and healthcare.
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Summary: Community Themes and Strengths Assessment                                           Page 63

This sense of unity was echoed by Hispanics in the Central Ward area. They often rally to the
aid of someone who is sick to raise funds for their care. Since many did not have health
insurance, such solidarity made a big difference in their lives. They were likely to share
information about availability of safe services that won’t compromise their illegal status. Many
cited the availability of shopping centers in the area. Some shops also offered job opportunities
to help ease the transition into the new environment. They also liked a recently cleaned park
nearby, but bathrooms were still unacceptable for use by parents and their children.

Easy access to many area health facilities was considered a plus by Central Ward participants.
And those in the South Ward who are close to the community health clinic liked that they can
walk to care, eliminating the barrier of transportation.

Central Ward participants also found local drug treatment service programs to be an essential
resource. “Everything is accessible [to a particular treatment facility]; you can catch a bus to
anywhere. The community has everything...a museum, Symphony Hall, welfare (office)…I
haven’t seen any crime but I’ve heard about it.” “This program has put structure back into my
life. I am a ‘relapser’ so it got me on track. I’m a mother; I have a job.” “The nearby park is
clean. I’m not from here but the last time I was here, a couple of years ago, it was dirty and now
is comfortable walking through. You can’t compare Atlantic City to here. Newark is much
better. It is cleaner; there are no drug paraphernalia on the ground.” These benefits reflect
community strength, give them hope and make the journey towards recovery easier.

Health Effects of Environmental Conditions
“Environmental conditions” include external and internal (home) factors. The violence
discussed above has health ramifications. From a public health perspective, the degree of stress
that area residents endure on a daily basis leads to the development of many chronic health
problems, including increased nervous tension.

The elderly consider teenage pregnancy a side effect of an environment that offers little in the
way of employment, quality education, self-esteem, and investment in children’s future. Many
youth are products of the DYFS child welfare system, a fall-out of the poor households and
neighborhoods from which they come. Children in the foster care system including those who
have aged-out, have never received affection from a caring parent. For them, any attention, even
negative, is better than none at all. The result is teen pregnancy for which many are unprepared.

Some youth are in households where parents work multiple jobs to make ends meet, or come
home late from their jobs. Thus many are left home alone and are sexually curious – having
relationships with much older individuals and inappropriate behaviors. These environmental
factors do not allow children to fully experience childhood. Compounding factors are absence of
a stable father figure in the home, multiple sexual partners of parents, or parents who are on
drugs. Some teenagers perpetrating crimes were drug-addicted babies. This causes problems for
children who are not trained to handle society, because their parents also lack the requisite skills.
As a result, many of the young children find the streets a comforting alternative.
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Summary: Community Themes and Strengths Assessment                                          Page 64

South Ward participants, including African American males, noted environmental health effects
including high levels of anxiety/depression and hypertension, resulting from fear of what goes on
in the community. Poor health conditions in community settings including feces, urine, spit, bed
bugs, rats and roach infestations, also affect their mental health. Even housing repairs took too
long, resulting in depression given the heightened sense of helplessness and hopelessness that
they felt. HIV/AIDS, syphilis and gonorrhea were rampant in their neighborhoods. One
participant had developed bronchitis and several other health problems because of the physical
condition of his apartment. Another said, “There are no windows where I live.” Many, we were
told, had been homeless prior to being placed in their current housing. Consequently they felt
that they had been forgotten by the system and abandoned in very dilapidated housing units.

An elderly African American male in the Central Ward stated, “My health is affected because of
all the violence in this community. I am afraid to come out of my house.” Another, a female,
added, “My health would improve if the crime went down. I am nervous all the time from the
gunshots.” Still another, speaking to the issue of health maintenance and medication compliance,
commented, “People are scared to come out of their homes because of the crime. Many of the
elderly we were told are shut-ins, afraid to go keep doctor’s appointments or any other that might
require them going to the bus stop and catching a bus. Also in the Central Ward, the health
effect of the environment was said to include obesity (child and adult), rising STD rates, and
substance abuse. Another participant countered that the children are not forced to eat junk food,
indicating that the problem of substance abuse is quite separate from eating habit, and so they
should not be lumped together. Another participant added, “It’s not always their choice that
these children eat junk food. When you got parents on drugs and these kids got to fend for
themselves, they feed themselves junk food. You don’t have to cook it. It’s cheap.”

Perception of Health and Common Health Problems
Participants were asked what they considered good health. To many, good health meant being at
peace with one’s self, being stress free, having no pain, feeling good about one’s self, good
mental and physical health, ability to eat right, being able to see a doctor, and saying a kind word
to those you come across on the street. Their main sources of stress were their community,
paying bills, and their children. Many were on fixed incomes, unemployed, and could not afford
to eat a healthy meal. Some were concerned for their safety and their children’s future.

In terms of area-specific perception, North Ward participants, a group comprised of Hispanic,
Italian and African American women, considered good health to mean having no health
problems, getting screenings such as Pap test and having physicals. It also meant absence of
stressed; absence of coughing; feeling good and not tired all the time; absence of depression;
absence of pain; eating well; and no need for medications. The elderly felt eating right, getting
around, going to bed at a reasonable time, taking vitamins, not smoking, being able to exercise,
and having an occasional drink meant good health.

Among Africans from all city wards, good health meant having access to prevention services,
being able to see a podiatrist, and to identify a problem and treat it before it gets worse. Good
eyesight, no problems bending over, and being physically fit meant they were in good health.
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Summary: Community Themes and Strengths Assessment                                           Page 65

Among Hispanics in the Central Ward, good health meant being healthy, with no pain anywhere,
and being stress-free. Among African American substance abusing women, good health meant
having no health problems, no pain, no need for medications, eating right, understanding the
body and knowing what to do to keep it healthy. Among the elderly in this ward, being in good
health included having physical mobility and waking up without experiencing pain.

Among the elderly in the South Ward, good health also meant having no pain, mobility, and
taking fewer medications. Among black females in this area, good health meant having “a
beautiful life,” feeling good, being happy, being in a good mood, being balanced mentally and
physically, and not having to take medications anymore.

Youth in the East Ward considered good health to mean feeling good about one’s self and being
able to see a doctor regularly

Whatever the definition, it was evident that many needed a less stressful life, ability to engage in
outdoor activities, fewer medications, and access to a health provider.

Common Health Problems
The health problems noted by participants were those often known to affect poor, minority
populations. These included hypertension, diabetes, high serum cholesterol levels, and obesity.
Often, these are lifestyle-related diseases, but the preponderance of these conditions among our
participants gave the impression that the physical environment in which they live has an effect
on their health. Increasingly, we heard about anxiety/depression and mental anguish that many
attributed to the crime-ridden, stressful environment. Some problems might also have been self-
inflicted, such as those related to drug use and gang violence. Others, however, are the direct
result of the physical environment. These conditions included lead poisoning, asthma, and others
associated with lack of access to helpful resources, such as gymnasiums and safe walking
corridors, exposure to poor physical environment, and well-stocked supermarkets. While our
population had a myriad of health issues common to the larger society, among many were often
diagnosed at advanced or late stages because of individual and system barriers to access to care.
Some have heart conditions that may have been triggered by smoking and/or substance abuse,
liver problems instigated by alcoholism, and stroke which may have been the result of poorly
managed hypertension and other related problems. Regardless of the cause of their health
problems, a combination of factors is to be blame.

The most commonly cited health problems among East Ward participants were hypertension,
lung cancer, uterine cancer, breast cancer, stroke, depression, cardiovascular diseases, diabetes,
high blood pressure, asthma, dental problems, anemia, HIV/AIDS, pain, allergies, arthritis,
stomach problems, and cirrhosis of the liver associated with excessive drinking. The elderly were
concerned about Alzheimer’s, Parkinson’s disease, and lead poisoning. Youth were concerned
about liver problems and asthma. Specific problems cited among Hispanics were allergies,
depression, arthritis, dental problems, and stomach problems.

In the South Ward, African American males noted that in the past there had been STDs that
could be treated if you contracted them. “Before HIV they had normal STDs; now they have
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Summary: Community Themes and Strengths Assessment                                          Page 66

killer STDs.” Other health problems included diabetes, hepatitis, HIV/AIDS, hypertension, liver
problems, depression and other mental health problems, tuberculosis, and homelessness. Among
the elderly, diabetes, arthritis, high blood pressure, and upper respiratory problems were the chief
complaints. But they had multiple health complaints. In the group of 12 participants, only one
had a single health problem, four had two health problems, and seven had three or more health
problems. Among females, kidney disease, low blood pressure, HIV/AIDS (nearly 80% of those
in the area), asthma, high blood pressure, cholesterol, and diabetes were primary concerns.

Among Central Ward elders, stress and depression were the chief complaints. One participant
was “bipolar and manic depressive.” Other conditions included prostate cancer, breast cancer,
diabetes, heart disease, and high blood pressure. Among African American males in the ward,
diabetes, HIV/AIDS, asthma, epilepsy, cancer, and high blood pressure were the dominant health
complaints. Substance abusers in Central Ward reported high rates of STDs and HIV/AIDS, as
well as breast and cervical cancer, hypertension and diabetes. Among Hispanic participants,
common health problems included heart disease, anxiety/depression, asthma, obesity, cancer,
arthritis, diabetes, eye problems, dental problems (which were too expensive to get treatment
for), stomach/digestive and thyroid problems. Two participants had heart disease, one had a
severe arthritis, two had stomach problems, one had cancer, and one had thyroid problems.

In the North and East wards, the major health challenges among Portuguese women were high
blood pressure, high cholesterol levels, chronic arthritis, and obesity. Males’ health problems
included hypertension and high cholesterol. Varicose veins were of added concern. Hispanic
participants cited dental problems and HIV/AIDS, common health problems in the area. Other
health problems included diabetes, high blood pressure, breast cancer, and lupus. HIV/AIDS
was prevalent among adults and young people, and was associated with drug use and unprotected
sex. While youths are aware of the importance of condoms, they are not using them to protect
themselves. Also in the East Ward, the elderly cited arthritis, Alzheimer’s, and asthma, which
they noted was related to unhealthy working conditions in factories that provided employment
for most adults. Children were also found to have asthma and lead poisoning.

Among Africans, common health problems included amputations, hypertension, diabetes, and
breast cancer. In the Liberian community, for example, about 25% of the women had been
diagnosed with breast cancer, and many were dying from the disease. The majority were women
in their 30s and 40s. They noted that the medical system lacks awareness of this special concern
within the African community. Hence the system has yet to identify the population’s risk factors
to minimize risk of late diagnosis, and improve health outcomes.

Youth in the Central Ward noted common health conditions of asthma, eye problems, obesity,
high blood pressure, high cholesterol level, diabetes, and heart problems. One participant takes
12 pills a day for her heart problem. Mental health issues were also noted. One participant had
tried on several occasions to commit suicide, and had been admitted to a psychiatric institution
for this problem. This individual believed that her family didn’t care about her. Among many,
however, depression was an ever-present health complaint.
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Summary: Community Themes and Strengths Assessment                                         Page 67

Of grave concern is the issue of HIV/AIDS and other STDs (e.g., Chlamydia, herpes, syphilis,
gonorrhea, crabs, human papillomavirus-HPV) among the city’s youth. Male and female youth
stated that each was the cause of transmission. They also displayed misinformation about
transmission by same-sex versus and heterosexual couples.

Among youth in the East Ward, common health complaints included heart murmur, dyslexia,
STD, asthma, and diabetes. The fact that some participants smoked (five), and consumed
alcohol (three) was said to be a result of peer pressure, and some were concerned about
developing liver problems. Many thought being cool and fitting in meant having friends, but this
offered a false sense of security. “If something happens, none of the so-called friends is going to
help out. Only real family and real friends who do not ask you to be something you are not, will
be there to help.” “Sometimes young people join groups and do negative things to get
protection.” One added, “What would I want to get protection from?” As with all adolescents,
individual choice versus peer pressure govern behavior.

Knowledge of Health Problems and Concerns
Participants shared stories about their families’ health histories and their own fears associated
with awareness of their families’ medical problems. E.g., one participant whose mother has
cancer and father has diabetes has a constant of fear of developing these problems, and is
worried by her experiences with her parents as they deal with these health issues.

Participants had some knowledge of the causes of common health problems. E.g., they attributed
asthma to exposure to dust, pollen, roaches, rodents, and poor housing conditions (such as lack
of heat and mold in the bathrooms). They noted high cholesterol was associated with depression,
the fact that they eat out of stress, and have no way of exercising. Some are nervous all the time,
and some have a nervous twitch. These environmental factors – stress and poor eating habits --
increase risk of diabetes and high cholesterol. Participants were very aware of the impact of
their own stressors, e.g., adolescent children, violence in their neighborhoods, on their health.
“These things cause me to eat a lot, which affects my health.” Another was concerned about his
asthma, and is unsure if he developed it from his smoking habit.

Lifestyle Changes
Participants are adopting some lifestyle changes including preventive health check-ups, attempts
to lose weight, and change their dietary habits by eliminating certain foods and eating on a
regular basis. Some now exercise, walk and run to the train station, or walk in the park. Most,
however, exercised in their own home. Some had visited the WIC program at Newark DHHS,
which was teaching them about healthy eating using the triangle chart.

In a group of 11 participants, eight smoked, two quit smoking 10 years earlier, and another quit
nearly two years ago. Four drank alcohol, and seven were recovering addicts, including one in
methadone treatment. Their drugs of choice were heroin, marijuana, and cocaine. These
individuals were all trying to adopt major life changes to improve their lives.

Many who have a health problem, such as those with breast cancer, noted that their condition had
made them depressed, and the lack of a support group compounded their problem. They too were
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Summary: Community Themes and Strengths Assessment                                        Page 68

looking to make changes in how they saw life to minimize their depression. Those living with a
chronic health problem such as diabetes, high blood pressure, or lupus were often irritated and
had mood swings. One with lupus was often stressed because of her health condition, and was
worried that she will not live to see her grandchildren. For some, lifestyle changes have included
smoking cessation, getting divorced, losing weight, and getting a driver’s license - which
provided a sense of self-actualization and confidence. Others talked about going back to school,
and simply needing to take a vacation away from the children

It was evident that participants used the informal network system for emotional support, material
assistance, instrumental help and information. Support systems included God, friends, family,
children, and parents. They allowed some time to adjust to new situations as they worked to
change aspects of their lives. For some participants, recognizing family histories of health
problems was a life-changing experience. Some attempted to gain new knowledge about the
specific diseases to make appropriate behavioral change. Another changed her eating habits
when her daughter was diagnosed with diabetes.

Lifestyle changes among youth included setting goals and going back to school. Some dreamed
about getting into college to achieve a dream, and were on that path (finishing their GED), or
were in college and committed to graduation. Another near-homeless individual living with
friends dreamed of owning a piece of land so he would always have a place to go. Other lifestyle
changes among youths included abstaining from sex or adopting safer sex practices.

Access to Care

Source of Health Care
Source of care, barriers to care and situations which prompted their use of care were wide-
ranging but constant among participants and wards.

Among 17 Central Ward residents, three had a private physician, 10 used hospital clinics, while
another two accessed regular health care through the emergency room. Four had visited the
emergency room within the prior 12 months, and one of these four had not received any type of
care because he did not have Medicaid.

In the case of 17 youths, contact with a health care provider often occurred following a potential
exposure to a STD. They were likely to go either to the Newark DHHS or a private physician’s
office. Some also use emergency room services, as indicated by seven of the 31 participants.

Central Ward seniors all reported having private doctors as their health care provider, which this
made going for regular check-ups easy. However, difficulty accessing prompt transportation
services made going for care a seeming problem. Their physicians accepted their health
insurance without any co-payment. Three elderly participants had used the emergency room in
the previous 12 months because of urgent conditions, and four had been hospitalized in the same
period. This population used a combination of private physician offices and ER care.
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Summary: Community Themes and Strengths Assessment                                        Page 69

Sources of care for African American males in Central Ward included the Newark DHHS which
was close to their homes. Seven of the 17 participants had been to DHHS for a number of
services, including flu shot. They noted that the welfare office sends them there for physicals.
One participant noted he used the DHHS STD clinic when he “got burned” (caught an STD).”

Hispanics in the Central Ward seek care mainly at the emergency room or clinics at UMDNJ, St.
Michael’s and Columbus hospitals. There are often too many people waiting to be seen, and
hence long waits for service. They feel they do not often receive adequate service, and blame
language barrier for this problem. ERs are often used since it often takes one to three months to
get clinic appointments. This population would also go to the clinic or ER to have a diagnosis
confirmed, and then write home to their country of origin for medication, because it is cheaper
there and may be more effective for their health complaints.

West Ward youth use hospital ERs and clinics as their source of care. African American women
also reported use of ER care. Because they often visit the ER late at night, the waiting time is
shorter than in their doctors’ offices. A Haitian male had visited the ER with a severe toothache,
but he was examined and sent home with nothing because he did not have health insurance.

In the North Ward, most Portuguese youth do not have a private doctor and visit local clinics for
their health care. They agree that going to the hospital requires a long wait and they are treated
disrespectfully because they are immigrants. They also believe that the medication they receive
is of poor quality. When sick, they feel most comfortable going to their mothers or a friend for
help. Among Latino youth, source of care is also hospital ER or home remedies. One
participant diagnosed with borderline cholesterol did not take any medications because he used
his mother’s home remedies and other alternative therapy, including change in diet. None of the
Portuguese women had a private doctor. They visit Newark hospitals and clinics only in a crisis.
Males go to the pharmacy and get over the counter remedies when sick, however.

In East Ward focus groups, Hispanic participants used private physician offices, hospital clinics
and ERs for their health care. These participants lacked health insurance and got charity care
from area hospitals. Others utilized home remedies when sick or changed their diets to minimize
risk of poor health. Among these participants, visiting a doctor is seen as the last option.

In North Ward groups, African American, Hispanic and white female participants used ER
services because they did not have a primary doctor and needed a prescription for blood pressure
medication. Although all but one of the participants indicated having a private doctor as their
health care provider, the tendency was to access care through the hospital ER. This is because
some doctors will not accept HMOs because of their restrictions. Eight out of 10 participants
went to the emergency room for asthma, bleeding, prescription refills and other concerns that
often require a private physician visit. Because most illnesses occur in the evening after local
community clinics and doctor’s offices were closed, it is only natural that they go to the ER
when they become ill. Others who had private providers also utilized ERs when they considered
their condition to be severe. Poor health conditions for this population included shortness of
breath and excessive coughing. They preferred using the ER at Clara Mass Hospital because
they felt that St. Michael’s and Columbus did not care about their patients, and that these
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Summary: Community Themes and Strengths Assessment                                          Page 70

facilities were prejudiced in the provision of care. Eight participants had gone to these ERs for
their children’s health problems and six had done so for their own health issues.

Many South Ward participants sought care either at the local community health center, a FQHC,
private physician offices or at the ERs at UMDNJ and Beth Israel.

In conclusion, a substantial proportion of participants sought care in emergency rooms and
hospital clinics even if they had private providers. This is because some could not reach their
providers during off-hours, their provider lacked expertise needed for their care, or waiting time
was too long. The general assessment is that the population often used multiple sources of care.

Barriers to Care

A number of factors have been found by researchers to create barriers to health care (source).
The study population was examined to determine the interplay of some of these known factors in
their ability to access timely, adequate and appropriate care. The factors included having
Medicaid, no insurance, difficulty getting appointments, inability to afford needed medications,
not being able to take time off of work for care, having to travel long distances for health care,
not having enough doctors (or dentists) in the neighborhood, and poorly kept doctor’s offices.
Some issues more than others were identified by participants as being a hindrance to the various
populations’ efforts to adequately access area health care services.

For some participants barriers to care included the lack of adequate private physician practices in
Newark. Patients felt they received better services from doctors located outside the city. Those
located in Newark were often overwhelmed because of the large patient population, many of
whom cannot afford transportation to seek care elsewhere. Many area practitioners have left the
city, creating a provider shortage in the process. The result is a huge volume of patients flocking
to these practices, creating overcrowding and the potential for inferior care.

Because there are fewer doctors there is a mistrust of those left behind. Participants consider the
current pool of providers crooked and insensitive to their needs. Many allow very little time for
quality patient-provider interaction. As a result many participants now visit hospital clinics for
their care, but felt that having student interns as their main health care providers also results in
inferior care, particularly in the areas of critical medical care. They felt that patients who have
good insurance plans receive better care at these sites than those who with charity care or no
health insurance. They felt this was also the case when a dental visit was made at the area’s
academic health center; those with good health insurance received better care.

Barriers to Care by Ward and Population

Central Ward: Among Central Ward participants, particularly African American males, barriers
to care included waiting time for appointment (between two and 12 weeks) particularly at
hospital clinics. Also, lack of health insurance was considered a major barrier to care, because
area hospitals were no longer readily offering charity care to the uninsured. “An uninsured
individual is likely to be given longer appointment waiting time at a clinic. Because charity care
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Summary: Community Themes and Strengths Assessment                                           Page 71

is no longer readily available, the hope is the patient will go elsewhere for health services.”
However, there seemed to be exceptions for traumatic conditions. Overall the perception was
that lack of insurance often resulted in delayed access to care and poor health outcomes. “They
don’t outright deny you. But once they find out you don’t have any insurance, they give you the
most basic care or tell you that you need to see your private doctor.” Participants reported an
inability to obtain a medical procedure, such as colonoscopy, because they were uninsured. “I
was trying for a month to get an appointment. I started going to the ER, but I got turned away
again for not having insurance.”

Participants were also concerned about the lack of sensitivity by health care providers, who were
often rude and condescending, with poor customer service. They were also concerned about the
nature of their relationship with their health care provider. They “wait all day” to see their
physician, who then “spends 10 minutes” with them. Importantly, the physicians will not “break
down the health information” and do not want to answer questions about your health.

Lack of access to medication was also a problem for many in this group. Among a population
that could not afford the co-pay, the fact that Medicaid paid for only half the cost of the
medication they needed seemed to offer no comfort or incentive to seek timely care. So access
to care was not considered a priority need. Consequently, many take over-the-counter
medications when they are ill, and wait until the condition worsens and then go to the ER. Many
agreed with one participant’s statement, “I just take Tylenol when I don’t feel well.”

Many expressed a lack of knowledge about some of the preventive health screenings, such as
colonoscopy. This lack of awareness of the test and its purpose meant they were less likely to
speak to their doctor about getting the procedure or to ask for referrals for such screenings.

Among Hispanic males, [high] cost of care was an issue. As a result, many used ERs for their
care. While this venue offered some care for their immediate health problem, the medical bill
they received following such visits was often too high, which discouraged future use. The
language barrier was also a deterrent to health care access. Seeking care was made difficult by
the fact that area providers did not speak their language and that available literature was often not
written in their language or education level. Other barriers included lack of funds to purchase
needed medications, lack of health insurance, and health insurance requiring a high co-pay.
Although six of the 12 participants had private insurance, many noted that their health insurance
did not often cover needed medical tests and/or diagnostic procedures. Although their insurance
paid for medications, the average costs were too high and they did not always have enough
money to purchase them. Often they would borrow money from relatives or go without required
medications. Some received help from prescription assistance programs, based on information
they’d seen either on television or posted at the hospital. However, the process of getting such
assistance was cumbersome, with too much paperwork, and some were not able to complete it.

Those with charity care considered the health care coverage they received insufficient. Charity
care is not transferable for use in any other [non-hospital] facility. Many considered the charity
care process too taxing with too many forms to be filled out and signed. One participant felt it is
better to pay for care and get out of there. We were told that one area doctor was now
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 72

considered the primary care physician for the majority of the Dominicans in the area; he is
trusted within the community. This physician would provide consultation services at a minimal
fee and even for free if the population was unable to pay for the cost of consultation. He refers
emergency situations the local ER and follows them there to offer continued care, thus providing
the informal support needed and technically competent care.

Among the population of substance abusers, those in rehabilitative programs in the Central Ward
consider the structured atmosphere of the health care system and their programs a barrier to care.
Health care visits require far more planning because an escort is needed to access care and they
must wait until one is available. Many of these individuals have been incarcerated, which means
they may not qualify for some government programs or must go through red tape for services.
Thus, many are uninsured and/or must wait awhile for Medicaid eligibility approval before they
can access certain services. Some with Medicaid were unable to have mammogram screenings
because Medicaid would not pay for the service. One participant with a family history of breast
cancer wanted screening but was unable to follow through because Medicaid would not pay for
the screening. Another needed an ovarian cyst removed and waited three months for Medicaid
approval. She has yet to receive her Medicaid appointment and was unsure if the delay meant
denial. Long waits for Medicaid approval results in delayed care and poor health outcome.

This population also considered the quality of care they receive inferior. One participant noted
that when she was arrested, she was not feeling well and complained to the doctor but nothing
was detected. Three Pap smears prior to her arrest were normal. However, after her arrest she
started having pains and the doctor ordered a biopsy. Results indicated a malignancy which had
spread to her ovaries. But she had been told by her doctor that the cancer had been diagnosed
early in the staging process. Another participant, a Puerto Rican female, detailed the inferior
care she felt she received, because ovarian cancer had not been detected despite her experiencing
pain in her abdomen area. However, these participants found the Newark DHHS to be a helpful
resource in the community. They were seen within two weeks of scheduling the appointment,
and were linked to other providers for additional services. Charity care was not an alternative for
this population, because the application process was cumbersome and it was expensive, with
unpaid bill sent by the hospital to collection agencies and credit bureaus. Emergency rooms
would not accept their Medicaid, so they are billed for services received from these sites.

Among the youth, barriers to care also included cost of medications and the personal choice of
not wanting to seek care unless the condition is dire, such as when they experience a burning
sensation that indicates a STD. Among this population, health care is not considered a priority.

For seniors, barriers to care include lack of transportation, lack of health insurance, fear of
venturing out of their home, and side effects of their medications. They felt that having a health
mobile would address issues of transportation, distance, and fear associated with going outside.
Many noted that they also take too many medications, and many are non-compliant with the
regimen they are given. Many of us take medications and then stop as soon as they feel better.
But they need to have more communication with their doctors, because some do not even realize
they really need to be taking their medications, some get medications without any direction or
guidance, and some cannot even read the instructions but are too ashamed to ask for help.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                            Page 73

For others, their environment is a factor in access to care. Many are shut-ins because of the fear
of violence and lack of safety they experience in their neighborhoods.

Nearly all elderly participants had health insurance, but had difficulty getting needed care when
needed it due to the restriction to network doctors (in managed care) and overbooked
appointments, leading to long waits in the office. Participants needing transportation must make
an appointment with the van service three to fours days before the appointment. Often the van is
late, and delaying the stay at the doctor’s office. Nine of the 34 focus group participants relied
on van transportation to care. Medical transportation vans appear to be changing their criteria,
requiring customers to be wheelchair-bound, many of whom do not qualify.

North Ward. Participants from the North Ward also discussed the difficulties of getting
adequate health care. Many have multiple health complications, and access to health care
providers is few and far between. Because they consume so many health care resources, they are
often asked to wait a certain duration of time before returning for additional services. One
participant had 13 surgeries in the previous years (repeated tumors) and the insurance company
was not willing to pay anymore until an emergency. Another had to wait for a second opinion
before receiving service. All of these individuals had private physicians. They felt that only
when you have an HMO are you likely to be seen by a provider when you need care. Those with
Medicaid often have problems seeking care. “Medicaid does not believe in preventive health
care. You have to wait until a problem has become critical for them to approve a health visit.
My son broke his finger and I had to wait for three weeks before he was able to see a doctor.”

Transportation was also considered a barrier to care. Some have to take two or more buses to
care. Combined with the uncertainty of receiving needed care they need when they arrive, it
becomes difficult to decide when to seek care.

They also were concerned about the type of care they receive, such that the potential of receiving
inferior care impacted their decision to seek care. It was common knowledge that one would
have to go outside of the city and switch doctors to be able to get the type of care needed.
Participants also indicated a lack of trust of area physicians. Others felt that doctors in their area
are crooked and would not give them needed medications particularly for pain. (Some felt that
physicians are selling theses prescriptions on the black market for lots of money, e.g.,
Oxycontin.) “As soon as you walk outside, you can sell your prescription.”

Having health insurance did not necessarily guarantee access to care. E.g., Medicaid has many
restrictions on doctors and pharmacies. Others said pharmacies that accept their insurance may
not be located in their neighborhoods, making access to medication another barrier to care. The
fact that one has seen a physician and received a prescription for an ailment does not necessarily
translate to adequate care. And one is not likely to keep a follow–up visit if the prescribed
medications have not been taken.

Transportation was barrier among North Ward residents. The fact that two weeks’ notice is
required for transport pickup to a doctor’s office means care would often be delayed.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 74

Other barriers included the location of services. The need to go to different sites for lab work
after getting care from a private providers means they are in no rush to access care. After
waiting a long time for an appointment, there is also a long wait to be seen at the provider’s
office. The fact that the interaction with their health care provider lasts only 5 to 15 minutes
made such long waits unacceptable. Many needed more time to ask questions or simply have the
doctor listen to them. Some physicians took the time to check everything and ask about their
symptoms, while physicians did so hurriedly. This was regardless of the doctor’s race/ethnicity.

Long waiting times before appointments and seeing a doctor was a deterrent for some and not for
others whose providers were cordial and sensitive to patients’ needs. The social distance
between providers and their patients is a hindrance to care. Some felt that doctors’ offices made
patients feel “like I am a nobody” which affects self-esteem. Among African American women
the long wait for appointment was a deterrent to care and was associated with lack of adequate
health insurance coverage, which limited health care options in terms of source of care.

Participants noted that you must first deal with the social services system to get health insurance.
They felt that city welfare employees who serve as gatekeepers are rude, judgmental, and
condescending. This population noted that physicians were no longer willing to prescribe certain
medications, given the potential of resale of the drugs or the prescriptions themselves on the
black market. This impacted their willingness to go for care because they were not getting the
prescriptions needed to address their health problems. The potential of being prescribed generic
drugs versus brand name medications was also a deterrent, as many consider them ineffective.

Eight of the 12 participants smoked. In the past Medicaid had paid for the nicotine patch, but
many patients sold the prescriptions on the black market so this service is no longer offered. Four
participants had a drinking problem, five were in recovery for heroin, cocaine and/or marijuana
addiction, and two were working on reducing the number of cigarettes they smoke per day.

Many providers have moved out of the North Ward area, leaving the neighborhood with a health
care shortage. Calling the hospital clinic for a health appointment requires a long wait, since
many who otherwise would have gone to neighborhood clinics now go to the hospital clinics.
Participants were often put on hold while the receptionist or registration staff attended to other
calls or patients at the clinic. This was considered a deterrent for many who now have cell
phones and are billed by the minute. The inability to reach caring staff right away made
attaining appointments difficult. More importantly, when an appointment is given, depending on
one’s health insurance, the waiting time could be anywhere from one to three months and longer.

Among Portuguese women, language is a definite barrier since health providers do not speak or
offer translator services in Portuguese. These women perceived treatment by office and health
professionals as demeaning and racist. There was overwhelming concern about long hours spent
in the emergency room as well as exorbitant charges for care. Several women claimed charges
of $2,000 and up for simple illnesses like sinusitis. The consensus is that since they do not have
insurance the hospitals order “very expensive evaluation tests”. None of the women had any
kind of health insurance and whenever they become ill they go to the pharmacy.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 75

Among Portuguese men, the high cost of care, particularly for a private provider, is a barrier to
health care access. Language is another barrier that causes much frustration. Long wait and
inadequate attention are experienced by most. Some feel they are treated like outsiders because
they are immigrants. Two have Medicaid, five have HMOs or a company-sponsored health plan,
and the balance had no insurance.

Latino youths were concerned about their undocumented status and the inherent inequities of the
health system as a result. The youth were often unconcerned about their own health, given their
perception that they were in good health. They were far more concerned about family members
with health problems who lacked access to care. Three males (college students) had mandatory
health insurance from their respective schools. Others had some type of government health
insurance. However, other family members including parents and siblings were uninsured.
When sick, they overwhelmingly felt more comfortable going to their mothers for help.

East Ward: Among East Ward participants, key factors in access to care were difficulty taking
time off of work, not having insurance, and cost of care. Many of the Hispanic participants did
manual labor, including babysitting and factory work. For them, taking time off is difficult
because they will not get paid for the day. Not getting paid means no doctor’s visit.

Among African American females, lack of health insurance and cost of medications were two
important determinants of access to care. The uninsured paid cash for their prescriptions and for
private doctor visits. Consultation fees of $60 were not uncommon. When they were unable to
pay the consultation fee, they sought care in the emergency rooms. Others have Medicaid and
find the requirements hindered obtaining timely and adequate care. E.g., one grandmother with
custody of her asthmatic grandchildren said that accessing care is difficult because of Medicaid
restricts the number of health visits per month (would not pay for two consecutive medical visits
in the same month). Participants needing to see a physician more than once for a medical
condition are forced to pay cash for that second visit.

Lack of health insurance was also a barrier to care among Hispanic and Portuguese youth in the
East Ward, many of whom were uninsured. Many seek care through the emergency rooms.
They were disillusioned about the type of care they received and the long waiting time for care –
“not like the ER program on TV.” Another was 22 years old, but felt as though he was 38 as he
was a heavy smoker, drank a lot, and worked in construction. His health was often bad, and
during these health episodes the ER is his only source of care, although he is often besieged by
large medical bills. The waiting time made him reduce the frequency of his ER visits, which
might be more productive if he did not have to wait until the problem was critical or severe. For
this participant, the emergency room is his medical home.

Respondents who pay cash for care find that physicians are often more responsive to their needs
than if they used Medicaid. Many have doctors who are located outside of Newark, including
Nutley and Irvington. For many in the Ironbound area they have to go to Bergen Street
(UMDNJ) and North Ward to find a doctor who will take their health insurance.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 76

Participants considered filling out medical forms for charity care an invasion of privacy. Many
Hispanic participants were afraid to share personal information, so as not to arouse suspicion of
the government. It is irrelevant that the health system is not connected to the federal immigration
system. Participants were often afraid of getting the large medical bills that often accompanied a
trip to the ER. Others were deterred because the health system could hold them accountable for
non-payment of medical bills of family members who they might have accompanied to care.
This population is also aware that charity care is hospital-specific and not transferable to any
other facility. If care is sought at another facility, they would again be asked to divulge their
personal information. In their view, the fact that this information is entered into a computer
means it is accessible to any government entity trying to determine their whereabouts.

Participants also indicated problems getting health appointments. Waiting one month for an
appointment was a problem because many could not start work until they had a physical.
Another called a doctor for an inflammation, received an appointment three months away and
had to go to the ER in the interim. Another who suffers from migraine headaches and allergies
said the cost of consultation was $120–$130, such that the only recourse is a visit to the ER.
Even those who go to hospital clinics find the waiting times too long. They felt that patients are
seen according to income at the clinic, and those with good insurance go first.

Many participants discussed the issue of medication as a barrier to health care. In one group of
15, nine took prescribed medications regularly. Most took at least three different medications
daily increasing to four to five among the elderly. Participants who paid cash for their care were
likely to get assistance with medications from their physicians. Many were on pain mediations
such as Percocet. It was not uncommon to go without medication or to send for medications
from their native countries (aspirin and penicillin).

It was relevant that participants did not consider the race/ethnicity of their physician a deterrent
to adequate care. The majority had doctors of a race other than their own; this did not influence
the type of care they received. Rather, insurance status was more of a determinant of the nature
and intensity of care received.

Participants from the East Ward visited the emergency room for reasons that included ear ache,
excessive vaginal bleeding or excessively long menstrual period, and tooth infection. However,
those for whom English is a second language noted the problem of language barrier and the fact
that they could not understand their doctors during most of those visits.

Participants had difficulty taking time off from work to keep a health care appointment. Because
they are not paid for time off, there is a delay between onset of illness and medical care to treat
the illness. Time off means loss of income and survival. They felt that they received inferior
dental care under Medicaid – particularly African American women. Another felt that
“Medicaid prefers that you remove your teeth, rather than to fix the dental problem or preserve
the teeth you have.” This population also had an issue with student interns providing care.

South Ward: Long waiting times due to overcrowded provider offices influenced health care
decisions among African American women. Doctors were making hospital rounds prior to
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 77

coming to the office, which causes a backlog and many patients waiting to be seen. Because
there are so few health care providers in the area, available providers often have large patient
volume. Waiting time of three to four hours was not uncommon.

South Ward youth found getting health care a hassle. Although nine out of 10 had insurance,
their choice of health care contact is the emergency room. Long waiting time at medical centers
was particularly difficult. Care in these facilities was not patient-friendly, was inferior, and took
too long. They considered a community hospital in the North Ward as a preferred option to the
other two facilities. At one hospital they felt they rarely saw “real doctors” only student interns.

Fear of the unknown was also a barrier to care. Some were afraid to find out that something was
wrong with their health. This mindset is a hindrance for many who felt “why should I find out
what is wrong with me, when I can do nothing about it?” The lack of control over their lives and
inability to navigate the health system means many are not in a rush to access care – and will
deal with it when it is a full-blown disease. It is no surprise that many participants had no
preventive health care in the prior 12 months. One participant diagnosed with prostate cancer
three years ago said that lack of motivation to seek preventive care was at the root of his delayed
diagnosis. He knew several men with a similar health problem, who waited too late to get care,
and were now deceased.

The long waiting time to see a doctor (three to four hours) and the inferior care they were likely
to receive from neighborhood doctors were often deterrents to care. One African American
female “prepares breakfast and lunch before leaving the house for the physician’s office.”

Among some populations, barriers to care included cost of medications, travel to the pharmacy,
side effects of medications, lack of easy access to transportation, and having Medicaid insurance.
Among some seniors who take from nine to 30 pills daily, the cost could range from $120 to
$300 per month. Given their fixed incomes, compliance with these medications would mean
forgoing everything else. So they are non-compliant, and hence follow-up care is often delayed.
Many also noted that side effects of medications made health care visits a daunting task, and
some will continue a course of treatment only if the medications had few or no side effects.

Black males in South Ward said that not getting needed medication was a barrier to health care.
Further investigation showed that many were selling their prescribed drugs to drug dealers and
others at very high cost. Hence doctors have become more skeptical about prescribing specific
medications. Some residents sell their medication if they run short of money during the month,
e.g., Methadone, Xanax, Percocet, and Oxycontin, used to induce a sense of euphoria.

For many who received care at the local community health center, barriers to care included the
availability of health care providers and sluggish patient flow. Most staffers take lunch breaks at
the same time, which leaves few to treat patients, disrupts patient flow and led to very long waits
for care - with four- to six-hour delays not uncommon. Further, the system does not provide
coverage when a provider is on vacation. Patients assigned to that provider must wait until their
return, which further delays access to care. A lack of specialists for many ailments common to
patients from this neighborhood results in doctors who “will just stop seeing you after several
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 78

years because your health problem has progressed beyond their capacity to treat.” Some felt that
waiting time at emergency rooms were shorter than those observed at health clinics.

Youth noted that because health care providers leave the community for more lucrative areas and
patients with better health insurance, it is difficult to know if one’s doctor is still in the same
location practicing medicine.

Substance abusers indicated that it is suicidal to combine prescription medications with their
illicit drugs. This factor impacted whether or not they would seek care. This population also
indicated they could not afford the cost of prescribed medications.

Lack of transportation was also viewed as a barrier to care. Medicaid covers most of their health
care needs but not transportation. As a result they are often unable to leave their neighborhoods
to seek care elsewhere, which is necessary given the shortage of health care providers in many of
these areas. Lack of transportation also impacted the nutritional health of the substance abusers,
who often must travel long distances (e.g., from the South to Central Ward) to buy food at the
large chain supermarket. This facility is the only supermarket chain that accepted their food
vouchers, but the van service to this store operates on a two-day-a-week schedule. The inability
to purchase food makes the issue of health care access less of a priority, even for a check-up.
Lack of trust of health care providers, inability to receive required medications, likelihood of
inferior care, and long waits time to be seen combine to yield more than enough reasons to make
health care secondary to the need for sustenance. The lack of information about available
resources makes it difficult for this population to know where to obtain much-needed services,
e.g., gynecological services, dental care, podiatric care, and nutrition education. Unless these
needs are met by the providers they consult, all other needs are viewed as less of a priority.

Newark At Large: The concern among participants from continental Africa was that they are
treated with disgust and carelessness. Physicians are disconnected from their patients, and lack
knowledge of “tropical medicine”. Hence, some seek care in far-away hospitals, such as Robert
Wood Johnson Hospital in New Brunswick. This immigrant population rarely goes for annual
check-up because health is not considered a priority. Their priority, we were told, included
working three or four jobs to amass funds to send to those back home, who are looking to them
for their daily survival. Fear of deportation was another barrier to care among this population.
The fact that they lack appropriate papers to stay in the country legally means they’ll make every
effort to avoid institutions that can potentially report them to the immigration services. They are
unaware that the health care system and the immigration system are two separate entities, and
that they will not be reported for lack of proper documentation.

Participants noted that elderly Africans are sent to UMDNJ for charity care, where they receive
poor care and are given medications that are not covered. Some have obtained private health
insurance for their elderly family members, which covers cost of medication. Many noted that
the lack of health insurance is a major deterrent to access to care, since they frequently work in
menial jobs that pay very little, or run small businesses that are unable to cover the cost of health
insurance. While this community is highly educated, its members often lack funds to afford
adequate care. Hence poverty is considered a major barrier to care.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 79

The impact of culture is pervasive among Africans. This population is more likely to defer care
not because it is not considered vital or that they lack knowledge, but because they have financial
obligations that must be met before their own needs. These include sharing their income with
other members of the family. For the most part, family members paid for the airline ticket the
U.S.; hence there is an obligation to send money back to those who sacrificed on your behalf.
These obligations are never completely met, as you basically owe these good Samaritans for the
rest of your life. When these individuals come to the U.S., they have no knowledge of the health
care system, lack financial resources, and are faced with cultural and language problems. The
nuances of the health care system serve as a barrier to care. As a result, most health problems
will first be treated with home remedies before mainstream medical care is sought.

Why do they choose not to address health issues is not cultural. Most Caribbean Islanders come
with the perspective that health care is free, so they do not have to allocate resources. This leads
to non–compliance and lack of treatment: when you are prescribed a seven-day dosage of
antibiotics (i.e., 14 tablets), you’ll likely only buy two pills because that’s all you can afford.

Lack of health care insurance was considered an important barrier to care. Not having adequate
health insurance results in patients getting substandard care.

Use of Health Department
Respondents visited the health department mostly to receive WIC, immunization (including
hepatitis shots), treatment for STDs, TB testing, and/or mammogram screening. Participants
were concerned that care was not offered free to the community. There is a sliding fee scale
based on income and may be a minimal fee as a result.

It was evident that the health department was not well known, and many did not know the nature
of care offered. Only three in 10 participants were aware of the facility, and only one in 10 may
have used the facility at some point. This is in spite of the population targeted, which includes
homeless, poor, and uninsured residents. It was indicated that while some of these participants
may have gone for a specific complaint, such as STD check-up, they were not likely to inquire
about the wide range of services offered at this facility. The obvious disconnect between the
community and the health department may help to explain the extensive lack of knowledge about
health and health issues pervasive in the community. The fact that a key function of the health
department - dissemination of health information – is not provided to a broad range of
community residents makes this a very relevant issue in the planning process.

Community Need

1.     Recreational programs, such as Boys and Girls Club to distract young people, as well as
       provide a safe haven for those who choose not to join gangs.

2.     Public gymnasiums or recreational facilities to increase family time between children and
       their parents. The goal is to strengthen families, a key factor in addressing the city’s
       social problems.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 80

3.    Health education workshops to increase awareness of HIV/AIDS and other sexually
      transmitted diseases, including herpes. The goal is to reduce the spread of the disease
      among at-risk groups, including the young and the elderly.

4.    Parent-centered health education that provides requisite skills for improved dialogue
      between children and their parents on issues pertaining to sexual behavior, nutritional
      health, and gender-based relationship negotiation skills, as well as addressing other
      health-related issues. E.g., the fact that five-year-olds were found to be engaging in what
      one participant called “smooching,” means health and sex education must begin early,
      and parents must be armed with the right information and skills to impart knowledge.

5.    Parenting skills classes to help strengthen families and minimize effects of social pressures
      that now consume most households. The need to elevate the role of parents in the lives of
      children is paramount to the effort to set a better course for the city’s youth. The fact that
      children lacked respect for self and parents and are no longer afraid of their parents
      decreases discipline. This impacts decision-making ability of the youth, and consequently,
      an overriding number are in jail, on parole, dead, or wreaking havoc in the city.

6.    Access to health care insurance for area residents to address a major barrier to early and
      appropriate care.

7.    Increased police presence in the community, with an eye towards community policing. Set
      up soccer, basketball, and baseball teams, as well as mentoring and tutoring programs
      headed by community police.

8.    Clean streets, Neighborhood Watch programs, accompanied by more traffic lights in high-
      risk areas.

9.    Courtesy parking spots for seniors or friendly and accessible transportation for seniors to
      enable them to purchase groceries and medications.

10.   An enhanced Meals-on-Wheels program to increase access to nutritional foods and
      decrease dehydration among seniors.

11.   Shelter facilities for the homeless.

12.   After-school programs that offer tutoring services as well as gang-prevention education
      programs for children.

13.   Cultural sensitivity training for social services and health care workers.

14.   Affordable housing to reduce homelessness and quasi-homelessness (e.g., doubling up
      with friends and family members). J

15.   Job training programs for ex-convicts to improve prison re-entry efforts, and help to
      stabilize those affected, including the communities in which these individuals now live.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 81

16.   More truancy buses and staff to reduce school drop-out, low literacy rate, and the potential
      for children to become victims or perpetrators of crimes.

17.   Initiative to encourage doctors to spend more time with patients in order to provide more
      extensive patient education.

18.   Community service for youths ages 14-19, designed as part of an overall effort to change
      youth behavior and achieve a sense of community ownership.

19.   Special Highlight: Parenting skills classes for young parents.

20.   Increased employment opportunities for working-age individuals. Work with local schools
      to create a career path for young people, to help guide decisions about their future.

21.   Implementation of workable social programs to help arrest the tide of violence, through
      strengthening of community ties with area academic institutions.

Suggestions for the Health Plan

1.    Engage cultural centers; schools including academic institutions of higher learning;
      churches; community-based organizations; and ethnic organizations in the dissemination
      of health information to the specific communities. Include medical professionals and
      celebrities in the dissemination effort. Also, relevant information about the plan and/or
      health issues affecting the community should be shared with these institutions for
      dissemination to their members.

2.    Meet with key leads in the different wards, and solicit their input on the development of
      the Health Plan.

3.    Implement universal health insurance to minimize prejudice in the health care system.
      Provide more information about plan coverage.

4.    Reduce use of student interns in area health institutions. Where necessary, provide
      information about their involvement in patient care prior to contact with patients.

5.    Encourage providers to prescribe brand name, not generic, drugs.

6.    Initiate a curfew for young people that would allow them to be home at a reasonable
      time. Assess a fine to parents whose children violate the curfew.

7.    Enforce dress codes in schools so authorities can more easily identify children who are
      trespassing in schools in which they don’t belong.

8.    Improve the education system to offer children a chance to dream about the future, and to
      achieve at the level of those in suburban communities.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 82

9.    Offer culturally sensitive and linguistically appropriate health education seminars for
      immigrant groups.

10.   Develop an information bureau to help immigrant populations, specifically Africans and
      Caribbean Islanders, assimilate more easily into larger society.

11.   Encourage hospitals to conduct educational sessions on Charity Care, its benefits and
      pitfalls. Provide information about private health insurance that can be purchased in lieu
      of Charity Care.

12.   Assist “prison re-entrants/parolees” in obtaining required documentation, including birth
      certificates, social security cards, driver’s license, etc.

13.   Increase police visibility in high-risk areas, and refocus the way in which the community
      is perceived and treated by the police.

14.   Expand the role of the health department to include an Information Bureau, so as to
      increase the community’s access to relevant information.

15.   Address the issue of patient flow and excessively long waiting time in area hospitals.
      Solicit input from patients on how best to achieve this goal.

16.   Provide mobile health services to reach the disenfranchised population, increase access to
      care, reduce ER visits, decrease non-compliance in chronic disease management, and
      address the special need for health care services among such populations as the elderly.
      Provide information on chronic disease management techniques.

17.   Encourage and offer incentives to health providers to locate their practices in Newark.
      Services of greatest need include ophthalmology, gynecology and obstetrics, pediatric
      and adult dentistry. Other public health areas: nutritionists, health educators, outreach
      workers, drug treatment counselors, and mental health counselors.

18.   Offer health information in Spanish, Portuguese, French and other languages to address
      language barrier to care.

19.   Expand health department services to better meet the needs of the city’s growing
      immigrant and uninsured populations. Recruit bi-lingual staff as part of the restructuring
      effort. Computerize the medical records system to enhance patient tracking and ensure
      continuity of care for those without a medical home.

20.   Offer mental health services that address the specific needs of children and adolescents.
      Include within this design recreational therapy and other age-appropriate modalities.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 83

                                     Community Forums


A total of five community forums (one per ward) were held from late 2005 to mid-2006 to
present the residents with data on health problems specific to each ward, to discuss the findings
of the ward-based focus group sessions conducted only a few weeks prior, and, most
importantly, to elicit information directly from the ward residents about what they perceived as
their health problems. They were led hosted by the Director of the Newark Department of
Health and Human Services. Further, it was assured that findings of communities’ participation
in the forums and focus group sessions would be disseminated to them. Newark DHHS also
provided information about general services of the health department and responded to specific
questions and concerns. Members of the Planning Partnership attended the forums and also
assisted in addressing residents’ concerns.

It was important to many residents that the views of members of their networks be included in
the city’s health plan. Focus group participants also wanted to gain information about their own
health, their specific community’s health, as well as to help identify possible solutions to some of
these important issues. As a result, once a site was identified, program partners were each asked
to mobilize their members to ensure their attendance at the forum. Many outreach methods were
used in to recruit participants including dissemination of flyers announcing the dates and times of
the forums and availability of incentives for attendees.

A total of 130 individuals attended the forums, and nearly two-thirds (60% or 78 attendees)
completed the forum evaluation and socioeconomic surveys. Assistance in completing the
survey forms was provided to those who could not speak English well (Spanish, Portuguese or
Creole) or who had less than an eighth grade education. Although all venues were well-known
public places (Newark city recreational centers and pools, community centers) some were
located in locations hard to reach by public transportation or through MapQuest for those with
private transportation, making attendance difficult for some. In some instances, attendees came
late or left early and may not have completed the surveys. These factors accounted for the
relatively low completion rate, although the target group was a captive audience.

Results of the Community Forum Evaluation


Table 1 highlights socio-demographic characteristics of forum attendees. Eighty-five percent (or
66) of respondents provided answers to these questions. Slightly more than half (52%) were age
40 to 54; while a small but noticeable proportion (18%) were age 26 to 39. The elderly
represented 11% of the respondents.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                       Page 84

        Table 1: Selected Demographic Characteristics of Forum Attendees (n=66)
    Age                                 %          Marital Status                   %
      18 – 25                          9%            Married                       23%
      26 – 39                          18%           Living Together               8%
      40 – 54                          51%           Single                        69%
      55 – 64                          11%
      65 or over                       11%         Education
                                                     Less than High School         11%
    Gender                                           High School/GED               44%
      Male                             43%           Some College                  11%
      Female                           57%           College Graduate or Higher    34%

    Race/Ethnicity                                 Employment Status
      African American                 62%           Employed                      52%
      Hispanic                         30%           Self-Employed                 12%
      White                            6%            Day Labor                     5%
      Other                            5%            Unemployed                    25%
                                                     Welfare                       7%
    Note: Due to rounding, some totals may not sum up to 100%

As shown above, 57% of respondents were female. Nearly two thirds (62%) were African-
American, 30% were Hispanic, while whites represented a much smaller percentage (6%). Only
23% of respondents indicated they were married, although another 8% noted they were living
with a partner. The majority (69%), however, were single.

Most (89%) attendees who provided responses to the survey had a high school education or
above. Better than two thirds (69%) had some form of employment, which included self
employment and day labor, while a sizable percentage were either unemployed (25%) or
received welfare assistance (7%).

Forum-Related Activities
Table 2 shows data on the community’s               Table 2: Descriptive Categories of Forum
perception of the forum. The goal was to                           Attendees (n=76)
generate additional data on issues               Categories                            Percent
discussed at the focus group sessions and        Interested Citizen                     40%
others posed by forum attendees                  N.J. Health Care System Employee        8%
responding to the focus group findings.          Community Leader                        8%
The data revealed that nearly two-thirds         Volunteer                              11%
of attendees described themselves by             Community Service Provider             26%
                                                 Healthcare Organization                 8%
affiliation with a group for the purpose
of the forum, as either “interested citizens” (40%) or “community service provider” (26%).
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                                         Page 85

Table 3 shows the reasons for attendance.                           Table 3: Reason for Attending the
Respondents wanted to learn how to help their                          Community Forum (n=77)
community or to get involved (43%), were                        Categories                                     %
assigned by their jobs (30%), wanted to hear                    Location was convenient                       14%
from the experts (21%), needed to express their                 To express my views                           17%
own views (17%), or found the forum to be                       Because of personal health problems            5%
conveniently located (14%).        Nearly half                  Because of family health problems             20%
attended the forums because of a personal or                    Because of ward health problems               20%
family health problem, as well as an increased                  Learn how to help my community or
awareness of the preponderance of health                        how I can get involved
                                                                Meet and hear from experts                    21%
problems in their specific wards. Regardless of
                                                                Assigned by my organization                   30%
their reasons for being there, nearly all
                                                                Curiosity                                     12%
respondents (97%) reported that they were glad                  Note: The figures in this table are not mutually
to have attended the forum.                                     exclusive, and so may overlap.

There was enthusiastic response to the forums. The reason was due to their improved knowledge
about local health issues. In fact, when asked how they felt about the information they received
through the forum, responses ranged from increased understanding about the city’s health issues
to increased knowledge about services offered by the health department to increase information
about family or personal health (Table 4).

      Table 4: How Attendees Felt About Information Received at the Forum (n=74)
    Categories                                                                                     Percent
    Increased understanding of city’s health problems                                              70%
    Increased understanding of services of the Newark Health Department                            50%
    Increased understanding of ward-specific health problems                                       39%
    Improved awareness of how to care for self and family in term of health needs                  35%
    Did not understand the information                                                             4%
    Overall, program met my expectations                                                           31%
    I would tell my family and friends about it                                                    38%
        Note: The figures in this table are not mutually exclusive, and so they overlap.

In fact, attendees reported they were now more aware that there was a health crisis in Newark,
and that lack of health insurance and social distance between health providers and the
community at large were contributing factors. They noted that the latter factors resulted in late
access to care and the perpetuated health disparities commonly experienced by Newark residents.
Nonetheless, those providing responses to the questions reported heightened awareness of such
diseases as asthma, diabetes, HIV/AIDS, high cholesterol and cancers, which they found to be
endemic in their various communities. Some of these health problems, namely prostate cancer
and HIV/AIDS, had a direct effect on their own lives. However, it was not uncommon for
respondents to report that they would share their new knowledge with others in the community,
as reported by 38% of the sample (Table 4).
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 86

Approximately 84% of those completing the survey indicated that their attendance at the forum
had changed their feelings about community health issues either a little (32%) or a lot (52%), and
almost all (93%) said they wanted to learn more about community health issues. Most
respondents had either a little knowledge or more than adequate knowledge of issues discussed,
but indicated the need for additional information. Many noted increased awareness about issues
facing adolescents in the community, such as suicide, depression, and other mental health-related
issues, as well as the impact of poor dental health on overall health and well-being.

However, when asked about the areas they were           Table 5: Areas of Interest Regarding
interested in gaining additional knowledge, the          Community Health Issues (n=65)
major areas of interest included weight and
obesity (62%), physical activities (52%),              Categories                           %
                                                       Physical Activities                 52%
substance abuse (46%), mental health (45%),
                                                       Overweight/Obesity                  62%
access to health care (42%), injury and violence
                                                       Tobacco Use                         28%
(35%), and responsible sexual behavior (29%).          Substance Abuse                     46%
See Table 5.                                           Responsible Sexual Behavior         29%
                                                       Mental Health                       45%
Overall, the community felt that conducting            Injury and Violence                 35%
workshops (63%) and presentations and panel            Environmental Quality               25%
format (55%) were appropriate ways of                  Immunization                        22%
disseminating information to the community.            Access to Health Care               42%
As a result, they wanted more contact between
the health department and the community, which these forums provided. However, a few
respondents indicated that they did not like the forum because they thought the presentations
focused largely on poor blacks rather than all minority groups. They also felt that the forums
were not adequately advertised.

It was evident that most attendees get their health information from community meetings (43%)
or their respective churches (36.2%). Newspapers and newsletters were also important sources
of health information. Personal contact with members of individuals’ networks contributed little
as a source of information. This indicates that residents go to formal sources for information.

Community Health Issues                                 Table 6: Five Major Characteristics of
                                                            a Healthy Community (n=65)
Project staff sought to generate responses as to
what the community considered the five most            Categories                        %
                                                       Low crime/safe neighborhood       72%
important factors that are characteristic of a
                                                       Good place to raise children      57%
“healthy community.” Results are presented in          Good schools                      55%
Table 6. The most frequently cited factor was          Access to health care             55%
low crime/safe neighborhood, which was                 Affordable housing                48%
identified by nearly three-quarters (72%) of the
respondents. Other factors included a good place to raise children, affordable housing, and
access to a good job. An equal proportion of respondents cited good school system and access to
health care services among the five most important factors depicting a healthy community.
While these issues were reported by most attendees, there were some variations across the wards,
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                     Page 87

for which data is available. For the North Ward, good jobs and healthy community was
considered a priority, while in the Central and West wards the main concern was low crime/safe
neighborhoods. Although not considered among the top five factors, other factors mentioned
included good jobs and health economy (41%), clean environment (33%), access to parks and
recreational programs (29%), and healthy behaviors and life styles (29%).

Also of importance to the Planning Partnership        Table 7: Five Most Important Health
were issues relating to health problems and risky      Problems in the Community (n=65)
behaviors in the community. Although these
issues were addressed in both survey and focus       Health Categories                     %
                                                     Five Major Categories
group sessions, it was important to determine
                                                      HIV/AIDS                          72%
how other members of the community felt about
                                                      Cancer                            43%
common health problems. In terms of the five          Diabetes                          39%
most important health problems, for example,          Sexually Transmitted Diseases     37%
attendees identified issues such as HIV/AIDS          Hypertension                      34%
(72%), cancer (43%), diabetes (39%), sexually        Other
transmitted diseases (37%), and hypertension          Child Abuse                       31%
(33%). However, it was not uncommon for               Mental Health                     23%
respondents to consider domestic violence,            Dental Problems                   22%
dental health and homicide as major health            Heart Disease                     22%
concerns in the community (Table 7).                  Homicide                          22%

As depicted in Table 8, risk behaviors, as perceived by forum attendees completing the surveys,
focused on drug abuse (86%), unsafe sex practices (74%), alcohol abuse (63%), dropping out of
school (63%), and being overweight (45%).
By ward, school dropout was considered more                Table 8: Most Important Risky
of a problem among Central (69%) and East               Behaviors in the Community (n=65)
Ward (56%) residents than those from other
wards. Alcohol abuse was reported as a problem        5 Major Risky Behaviors           %
                                                           Drug Abuse                  86%
by both West Ward (86%), and East Ward
                                                           Unsafe Sex Practices        74%
(66%) residents. Although teen pregnancy was
                                                           Alcohol Abuse               63%
not reported as a major problem, East Ward                 School Drop Out             63%
residents (56%) considered it a risky behavior             Overweight                  45%
among its teenage population. Respondents also        Other
noted the cost of care (which they said was                Tobacco Use                 34%
extremely expensive), and lack of knowledge of             Poor Eating Habit           31%
environmental risk factors as additional forms of          Lack of Exercise            31%
risky behavior.

Healthy Communities and Self. Respondents were asked to rate the level at which the
community could be considered a “healthy community” using a five point scale, with 5 being
“very healthy” and 1 “very unhealthy.” The largest percentage of respondents reported that the
community was unhealthy - slightly more than half (51%) rated the community as either “very
unhealthy” (14%) or “unhealthy” (37%). A much smaller percentage (14%) of respondents
thought the community was either “healthy” (9%) or “very healthy” (5%). When ward-specific
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                           Page 88

responses were considered, the majority of residents of West (71%) and North Wards (53%)
viewed their communities as “unhealthy,” while a substantial proportion of East (44%) and
Central Ward (43%) residents thought their communities were “somewhat healthy.”

Respondents were also asked to rate          Table 9: Attendees’ Perception of Health of
their own health using the same rating               Community and Self (n=65)
scale. An equal proportion considered                              Community        Personal
themselves to be either “somewhat                                     Health         Health
healthy” (40%) or “healthy” (40%).        Very Healthy                  5%             12%
See Table 9. The reasons for feeling      Healthy                       9%             40%
healthy included the fact that they       Somewhat Healthy             35%             40%
took daily walks, exercised, visited      Unhealthy                    37%             3%
their physicians regularly, had regular   Very Unhealthy               14%             2%
screenings, or had changed eating         No answer                     0%             3%
                                          Total                       100%            100%
habits. The sense of feeling unhealthy,
which was indicated by 5% of respondents, was associated with having a chronic health problem,
not knowing where to go for exercise including walks, and poor dietary habit, which included
eating a sizeable amount of sweets daily.

Payment for health care. It was relevant to               Table 10: Method of Health Care
determine how residents pay for health care. As         Payment Indicated by Attendees (n=66)
shown in Table 10, only a small proportion said                 Payment Type                 %
they paid cash for care (15%) or had charity care       Pay Cash (no insurance)             15%
(3%) because they were uninsured. Those with            Charity Care                        3%
charity care also had to pay cash for care when         Health Insurance (HMO)              26%
care was sought outside of a hospital setting, or       Private Insurance (Employer)        21%
when paying for medications and specific health         Medicaid                            26%
care procedures. Most attendees, however, either        Medicare                            3%
had Medicaid (26%), private insurance through           Other (VA)                          6%
their employers (21%) or an HMO (26%).                  Total                              100%


This component of the MAPP study is one of four data collection methods used to engage the
community and garner their involvement and support for the development of the health plan.
The data offer additional insight into residents’ perceptions about their specific community, their
personal health, and areas where more information was needed. Forum attendees discussed the
need for more focused services for adolescents, such as improved reading skills, which were
reported to influence social behavior. One attendee noted that because many adolescents have
developmental disabilities, which affect school performance, the tendency is for these students to
act out, and/or to drop out of school. It was indicated that if these children are not identified and
helped by the time they enter forth grade, many would fall through the cracks.

Other issues pertaining to children and adolescents are the lack of parks and/or recreational
activities located close to their homes. The absence of these facilities were said to impact the
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                        Page 89

health of children, many of whom are now overweight/obese and/or affected by respiratory
problems and lead poisoning, as many stay indoors and afraid to venture out of their homes.
While these issues were common among all wards, the South, West, and Central Ward residents
found lack of play areas to be more of a concern in their community. Expanding on the issue,
attendees also pointed to the need to provide youth with recreational services that go beyond the
regular hours of 4 to 8 p.m., when many basketball programs offered in school gyms conclude
for the day. The point was made that many of these youth have nowhere else to go after those
hours, leaving them vulnerable to mischief, negative peer influences, and violent behavior -
including gang violence, car theft and drug dealing. Since many did not have parents available
to provide supervision and guidance, the tendency was for these youth to follow their peers to
either their “hang outs” or homes, where they were likely to engage in negative social behavior.

There are other concerns including the preoccupation with television programs, which is an
increasing concern among parents who must leave their children indoors because there is nothing
in the community to meet their recreational needs. The fact that TV programs espouse violence
means that parents have an additional issue to deal with in their homes. The lack of community
support to help change child and youth behavior is a cause of concerns for many parents. One
attendee pointed out that in the old days, they went outside to play, and when they did something
wrong, they were sent to their rooms. Now if you sent a child to their room, you actually
sanctioned them playing with their Ipod, computer, or watching inappropriate TV programming.

Data show that while less than one-quarter of the forum attendees indicated that environmental
health is a concern, high crime rates and risky behavior put many residents in a precarious
position. Among many youths, they do not believe they will live past age 25. Attendees’
concern, however, is what the community can do to provide hope, reduce despair and generate a
zest for living among the youth. The lack of hope means that many do not take care of
themselves and, by their actions, seek to put the health of others in jeopardy.

Absence of a dominant male presence was considered a precursor for adolescent mischief. For
many adolescents the school environment is a safe haven, even though school yards, hallways
and classrooms offer their own sets of social challenges. This is because presence of a dominant
adult – in the form of a principal, teacher or guidance counselor - offered some protection from
violence and peer pressure that they are normally exposed to outside of school. It was not
uncommon for even the home environment to offer more stressors – including the fact that youth
may encounter a parent who is a drug addict or other adults who expose them to violence or
sexual activity. Also discussed is the fact that adult males in the family suffer enormous stress
taking care of their households. Because there are no outlets for the children who are then forced
to stay indoors, there are little opportunities for these working adult males to relax. As one
attendee explained, “Just getting a good night’s sleep is now a problem.” This issue was of
specific importance to West, Central and North Wards forum attendees.

Expanding on this issue, of extreme relevance to the North Ward is the fact depression and other
mental health issues are commonplace among African American males. There is a stigma with
having mental health problems. Hence, those who are found to have mental health issues deal
with these problems by going to church, praying, and getting their hair done. West Ward
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                          Page 90

attendees found poor health care seeking behavior an issue among African American males.
Many men in the community work and take of their families, neglecting their own health.

Changing the perception of an unhealthy community may be difficult to accomplish, particularly
when residents associate their communities with high crime rates, high prevalence of chronic
diseases, poor performing schools, lack of access to health care and health insurance, poor
dietary habits, and unhealthy personal lifestyles. Common among these factors is the issue of
poor quality of life. Many residents do not have access to well-stocked food stores selling fresh
fruits or food items. Consequently, they buy unhealthy items because that is all that is available.
Many store shelves carry expired meats, fish and poultry, and other expired items required to
achieve healthy living. Thus, even when individuals are willing to change their lifestyles, the
choices available to them make it difficult to do so. As one attendee put it, “How can you
stabilize high blood pressure and cholesterol, when all the food around you is bad for you?” She
continues, “And then we have bird flu problem, and we cannot eat the chicken. It seems like we
are just guinea pigs.” In fact, West Ward residents considered poor diet a major health concern
among them. Exacerbating the issue of poor nutrition is the fact that meals available to children
in schools may also not be healthy or of good quality. It was suggested that health department
staff should visit the schools and conduct health and lifestyle education there as part of an effort
to get the community to change health behavior starting at a younger age. The notion is that
while we are the wealthiest nation in the world, our children are very unhealthy, a contraction.

Attendees also felt the need to improve their personal health, but found that the lack of safe areas
for walking to be a hindrance. Streets are often littered with garbage, there is increased risk of
care accidents and encounters with reckless drivers, and the potential of being mugged is an
ever-present danger. The fact that one cannot go to parks outside of their neighborhoods without
access to private transportation, means that health problems common among Newark residents
will persist. Due to a largely sedentary lifestyle among residents, diabetes, high cholesterol,
hypertension, and other related health problems are said to be endemic in these neighborhoods.

Substance abuse and other risky behaviors predominate in these communities. In the South
Ward, for example, residents are afraid of an increase in the HIV/AIDS rate among their youth.
Also in the South Ward residents found substance abuse a precursor for many of their health and
social problems and indicated the need for drug treatment programs for all populations.

Although only a small percentage (15%) paid cash for health care, many found access to health
care to be problematic, including those with charity care and Medicaid. Many area doctors do
not accept Medicaid, which meant delayed care because physicians accepting Medicaid are
located outside the area. Many area providers did not have the specialization needed to address
their specific health issues, which also translated to “delayed care” or, as one attendee noted,
“you go home, lie on your bed and just pray.” For many Latino residents of Newark’s North
Ward, the first line of care was often their mother or a close relative, who was often available to
provide home remedy for their ailment. Forum attendees across all wards found the lack of
health insurance a factor in access to care and to quality health care. Those with charity care said
they were seen too late when they arrived for care either in the ERs or clinics, are offered
mediocre care, and are often sent astronomically high medical bills for services rendered.
Newark Health Plan
Summary: Community Themes and Strengths Assessment                                         Page 91

The receipt of a medical bill is often a surprise, since it is assumed that charity care means free
care. It was not uncommon for an individual to be sent for mammography and have to pay for
another doctor to read the x-ray – although the mammography itself is free. Per one attendee,
“What use is it to go for screening when you are not going to get the results because you do not
have money to pay for someone to read it?” Others noted that if the result of a cancer screening
is positive, you now have to worry about getting adequate treatment if you do not have health
insurance to cover the cost of care. This fragmentation of care leaves many confused and
frustrated. The outcome often is late entry into care. Compounding the access problem is the
cost of prescription drugs. Many attendees pointed to the increasing cost of prescribed drugs,
noting that many go without needed drugs because they cannot afford to buy them. Central Ward
residents noted that charity care does not cover needed diagnostic tests (such as CAT-scan
readings) and that many illnesses go untreated because they cannot afford the cost of medication.

For many East and North Ward residents, language barrier and immigration issues are factors
impacting access to care which aggravate lack of health insurance. Fear of being deported and
the inability to navigate the health system because of lack of English language proficiency makes
access to appropriate, adequate, and timely care a rare occurrence. As North Ward residents
noted, they are not treated well because of their immigration problems, and doctors do not spend
enough time with them because they are often unable to express themselves or ask appropriate
questions. As one attendee noted, “because we are poor, we are told, you have 15 minutes.”

Many issues facing area residents cannot be resolved overnight and may require enormous
investment in time and human resources to achieve meaningful change. Central Ward residents
envisioned the old days when doctors made house calls. This was often a problem among
seniors who now find themselves afraid to leave their homes or lack access to transportation to
care when needed. “We are told doctors nowadays worry about money not their patients.” As
one attendee noted, “first they ask what type of insurance you have and the co-payment. The
city is now filled with poor people who have charity care and are forced to see “student doctors”
instead of the “real” doctors when they go to hospitals for care. Even timing of contact with a
physician in the ER is dictated by one health care insurance. Those with no insurance or charity
care are placed in the back burner and may not be seen for several hours until all those with
health insurance have been attended to. Further, there are more immigrants arriving in the city
who are mostly uninsured and lack skills and social and financial resources required to sustain
adequate living. Consequently, health disparities are likely to persist among city residents.

This study was limited by reliance on data from persons proficient in English and small sample
size. Nonetheless, the study raised important questions about community strengths and
weaknesses, and identified areas where the health department and its many partners can make
meaningful differences. Paramount is education on lifestyle issues. The health department can
create a speakers bureau to target vulnerable populations for health education. Newark DHHS
should strengthen the links with its many partners, including recreational programs, the police
department, area schools, health insurance companies, hospitals and others crucial in the effort to
move the city toward “healthy living.” The issue of coordination and integration of care is
increasingly vital if the goal is to improve the overall health and well-being of residents.
Newark Health Plan
Summary: Community Themes and Strengths Assessment    Page 92

           PARTNERSHIP (M.A.P.P.)
   Staffing, Facilitation & Technical Assistance
                    provided by:
     Maria E. Vizcarrondo, Director of Child & Family

         Rawaa Albilal, Director of Strategic Planning,
           Resource 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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