2016 Community Health Needs Assessment Bergen County, New Jersey Prepared for: The Community Health Improvement Partnership of Bergen County Bergen County Department of Health Services Christian Healthcare Center/Ramapo Ridge Psychiatric Hospital Englewood Hospital and Medical Center Hackensack University Medical Center Hackensack University Medical Center at Pascack Valley Holy Name Medical Center The Valley Hospital Prepared by: Professional Research Consultants, Inc. 11326 P Street Omaha, NE 68136-2316 www.PRCCustomResearch.com 2015-0991-02 © October 2016 COMMUNITY HEALTH NEEDS ASSESSMENT Table of Contents Introduction 7 Project Overview 8 Project Goals 8 Methodology 9 Summary of Findings 17 Significant Health Needs of the Community 17 Summary Tables: Comparisons With Benchmark Data 21 Community Description 42 Population Characteristics 43 Total Population 43 Urban/Rural Population 45 Age 46 Race & Ethnicity 48 Linguistic Isolation 50 Social Determinants of Health 52 Poverty 52 Education 55 Employment 56 Housing Insecurity 56 Food Insecurity 58 High-Need Areas 60 General Health Status 63 Overall Health Status 64 Evaluation of Health Status 64 Activity Limitations 66 Caregiving 68 Mental Health 70 Evaluation of Mental Health Status 70 Depression 72 Stress 74 Suicide 75 Mental Health Treatment 76 Key Informant Input: Mental Health 78 2 COMMUNITY HEALTH NEEDS ASSESSMENT Death, Disease & Chronic Conditions 81 Leading Causes of Death 82 Distribution of Deaths by Cause 82 Age-Adjusted Death Rates for Selected Causes 82 Cardiovascular Disease 84 Age-Adjusted Heart Disease & Stroke Deaths 84 Prevalence of Heart Disease & Stroke 87 Cardiovascular Risk Factors 89 Key Informant Input: Heart Disease & Stroke 96 Cancer 98 Age-Adjusted Cancer Deaths 98 Cancer Incidence 101 Prevalence of Cancer 102 Cancer Screenings 104 Key Informant Input: Cancer 109 Respiratory Disease 112 Age-Adjusted Respiratory Disease Deaths 113 Key Informant Input: Respiratory Disease 116 Injury & Violence 118 Unintentional Injury 118 Intentional Injury (Violence) 124 Key Informant Input: Injury & Violence 130 Diabetes 131 Age-Adjusted Diabetes Deaths 131 Prevalence of Diabetes 133 Key Informant Input: Diabetes 135 Alzheimer’s Disease 137 Age-Adjusted Alzheimer’s Disease Deaths 137 Progressive Confusion/Memory Loss 138 Key Informant Input: Dementias, Including Alzheimer’s Disease 139 Kidney Disease 141 Age-Adjusted Kidney Disease Deaths 141 Prevalence of Kidney Disease 142 Key Informant Input: Chronic Kidney Disease 143 Septicemia 144 3 COMMUNITY HEALTH NEEDS ASSESSMENT Potentially Disabling Conditions 146 Arthritis, Osteoporosis, & Chronic Back Conditions 146 Key Informant Input: Arthritis, Osteoporosis & Chronic Back Conditions 147 Vision & Hearing Impairment 148 Key Informant Input: Vision & Hearing 150 Infectious Disease 151 Influenza & Pneumonia Vaccination 152 Flu Vaccinations 152 Pneumonia Vaccination 153 HIV 154 Age-Adjusted HIV/AIDS Deaths 155 HIV Prevalence 155 HIV Testing 157 Key Informant Input: HIV/AIDS 157 Sexually Transmitted Diseases 158 Chlamydia & Gonorrhea 158 Safe Sexual Practices 159 Key Informant Input: Sexually Transmitted Diseases 160 Immunization & Infectious Diseases 161 Key Informant Input: Immunization & Infectious Diseases 161 Births 162 Birth Outcomes & Risks 163 Infant Mortality 163 Key Informant Input: Infant & Child Health 163 Family Planning 165 Births to Teen Mothers 165 Key Informant Input: Family Planning 165 Modifiable Health Risks 167 Actual Causes of Death 168 Nutrition 169 Daily Recommendation of Fruits/Vegetables 170 Access to Fresh Produce 171 Sugar-Sweetened Beverages 174 Physical Activity 176 Leisure-Time Physical Activity 176 Activity Levels 178 Access to Physical Activity 181 4 COMMUNITY HEALTH NEEDS ASSESSMENT Weight Status 182 Adult Weight Status 182 Children’s Weight Status 186 Key Informant Input: Nutrition, Physical Activity & Weight 188 Sleep 190 Substance Abuse 193 Age-Adjusted Cirrhosis/Liver Disease Deaths 193 Alcohol Use 194 Age-Adjusted Drug-Induced Deaths 196 Drug Use 197 Alcohol & Drug Treatment 200 Negative Effects of Substance Abuse 201 Key Informant Input: Substance Abuse 202 Tobacco Use 205 Cigarette Smoking 205 Other Tobacco Use 209 Key Informant Input: Tobacco Use 211 Access to Health Services 212 Health Insurance Coverage 213 Type of Healthcare Coverage 213 Lack of Health Insurance Coverage 213 Difficulties Accessing Healthcare 216 Difficulties Accessing Services 216 Barriers to Healthcare Access 217 Accessing Healthcare for Children 220 Key Informant Input: Access to Healthcare Services 220 Health Literacy 223 Understanding Health Information 223 Completing Health Forms 224 Population With Low Health Literacy 225 Primary Care Services 227 Access to Primary Care 227 Specific Source of Ongoing Care 228 Utilization of Primary Care Services 229 Emergency Room Utilization 231 Advance Directives 233 5 COMMUNITY HEALTH NEEDS ASSESSMENT Oral Health 235 Dental Insurance 235 Dental Care 237 Key Informant Input: Oral Health 239 Vision Care 240 Local Resources 242 Perceptions of Local Healthcare Services 243 Healthcare Resources & Facilities 245 Hospitals & Federally Qualified Health Centers (FQHCs) 245 Resources Available to Address the Significant Health Needs 246 Appendices 250 Appendix I: Peer County Comparisons 251 Selected Data Charts 251 County Health Rankings 263 Appendix II: Special Populations 266 Health Needs of Korean Residents 266 Health Needs of African American Residents 269 6 Introduction COMMUNITY HEALTH NEEDS ASSESSMENT Project Overview Project Goals This Community Health Needs Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Bergen County. Subsequently, this information may be used to inform decisions and guide efforts to improve community health and wellness. A Community Health Needs Assessment provides information so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This Community Health Needs Assessment will serve as a tool toward reaching three basic goals: To improve residents’ health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents’ health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. This assessment was conducted on behalf of the Community Health Improvement Partnership of Bergen County by Professional Research Consultants, Inc. (PRC). PRC is a nationally recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments such as this in hundreds of communities across the United States since 1994. Subsequent implementation planning for the county and hospital sponsors, based on the findings of this assessment, will be conducted with the assistance of Strategy Solutions, Inc., a consulting group with more than 20 years of experience in community health planning. 8 COMMUNITY HEALTH NEEDS ASSESSMENT Methodology This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes primary research (the PRC Community Health Survey) and secondary research (vital statistics and other existing health-related data); these quantitative components allow for trending and comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through an Online Key Informant Survey. PRC Community Health Survey Survey Instrument The survey instrument used for this study is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues. The final survey instrument was developed by the Community Health Improvement Partnership of Bergen County and PRC and shares some commonality with a previous survey used in the region, allowing for some data trending. Community Defined for This Assessment The study area for the survey effort is defined as each of the residential ZIP Codes comprising Bergen County, New Jersey, subdivided into six county subregions. This community definition is illustrated in the following map. 9 COMMUNITY HEALTH NEEDS ASSESSMENT Sample Approach & Design A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Community Health Survey. Thus, to ensure the best representation of the population surveyed