This paper is an assessment of the city of Rockaway Township, New Jersey. It explores the community with a focus on the demographics, social and physical environments, community strengths and assets, health behaviors and outcomes, and healthcare access and utilization. Furthermore, a target population within Rockaway Township served by the student's clinical site (Birchwood Elementary School) is identified, as well as their corresponding unmet health needs that would be amenable to a community health educational program in hopes of improving the health of the community.
Community Health Assessment
Community health assessment is the very first step in achieving the main goal of public health: improve the health of a population. A community health assessment provides a portrait of a community's health status to eventually develop public health interventions and evaluate their effectiveness using a similar approach (Cibula, Novick, & Sutphen, 2003). Supporting this, Centers for Disease Control and Prevention (2015) states that by providing organizations the comprehensive information of the community which involves the current health status, needs, and issues, a community health assessment can help develop a community health improvement plan (CHIP) to improve overall community health.
This paper is a community health assessment of Rockaway Township, a township in Morris County, New Jersey. Rockaway is an extremely ethnically-diverse city. Residents of Rockaway describe themselves as belonging to a variety of racial and ethnic groups. According to the United States Census Bureau, Rockaway Township covers an area of 45.54 mi² with about 25, 494 residents as of July 1, 2017. It is mainly composed of 77.2% Caucasians, 10.7% Hispanics, 6.6% Asians, 3.4% African Americans, and 3% for other races; 6.4% persons under age of 5, 22.2% persons under 18 years, 16.6% persons 65 years and over, and 51.5% female persons. The median age is 42.6. The median household income is about $103, 990 which is classified to be in the upper middle class. There is, however, still a 3.4% in poverty. The religion statistics show that 40.2% are Catholics and very surprisingly, the next majority is 40% of non-denominational. Others are mainline protestant, evangelical protestant, black protestant, and orthodox. Education statistics show that 95.9% of persons age 25 and older are high school graduate but only 47.8% of persons age 25 years and older have a Bachelors' degree or higher.
Social and Physical Environment
US Census Bureau (2017) lists 15% of the total population in Rockaway Township as foreign-born. The top language spoken is English, followed by Spanish. There are 9, 110 households with an average of 2.7 persons per household. There are 9, 823 housing units in this town, with the 81% of them are single-units. The median value of owner-occupied housing units is $341,900. In addition, mean travel time to work is 30.1 minutes, with 84% of the population drove alone. Others carpooled, utilized public transportation, or worked from home. Rockaway is surrounded by grocery stores (103), convenience stores (98), hospitals (7), colleges/universities (7), libraries (2), banks (~10), churches (18). There are six elementary schools (Birchwood Elementary School, Catherine A. Dwyer Elementary School, Katherine D. Malone Elementary School, Dennis B. O'Brien Elementary School, Stony Brook Elementary School, St. Cecilia Elementary School) that serve students in kindergarten through fifth grade in Rockaway Township, two middle schools (Copeland Middle School and Sacred Heart School) for students in sixth to eighth grade, and two high schools (Morris Hills High School and Morris Knolls High School) for students in ninth through twelfth grade. History of crime incidences in 2016 only showed 12 burglaries, 71 thefts, 3 auto thefts, 4 robberies. No murders, rapes, assaults, and arson. Environmental issues in Rockaway Township is overseen by the Environmental Commission. They are responsible for the protection, development or use of natural resources, including water resources located within the Township.
Community Strengths and Assets
Rockaway residents are engaged in their community. There are several organizations where residents actively participate. Civic organizations include American Association of University Women (AAUW), Rockaway Township American Legion Auxiliary, Rockaway Township Community Partnership for Persons Disabilities, etc. Cultural organizations include Germania Park, Irish-American Organization of New Jersey, Sisterhood of White Meadow Temple, etc. Religious organizations include Christian Fellowship Church of God, First Presbyterian Church of Rockaway, St. Cecilia Roman Catholic Church, etc. Senior organizations include Rockaway Township Senior Citizens – Social Club, State Health Insurance (Assistance) Program S.H.I.P., White Meadow Lake Senior Friendship Club, etc. Children's organizations include Boy Scouts of America, Cub Pack, Girl Scouts of Northern N.J., Handicapped Children's Committee of the Lake Hopatcong Elks, etc.
In addition to focus groups that bring community cohesion, Rockaway Township also has large number of support and services provided to the residents. The Division of Health takes pride in its many free and discounted health screenings and clinics that are carried out at various times throughout the year. The health services offered include diabetes screening, female and male cancer screenings, flu/pneumonia clinics, and semiannual cholesterol/blood chemistry clinic. Monthly screenings are provided at the Hibernia Health Center, located on Green Pond Road. Furthermore, free monthly cardiovascular screenings, free skin cancer screenings and free quarterly themed health education seminars to residents on certain health topics like stress management, diabetes, nutrition and parenting are also provided by the Division of Health, in cooperation with the Rockaway Township Public Library. The Township also participates in the federal Vaccines for Children program. During the Division of Health's monthly child conference services, infants and children who are eligible may receive free vaccinations and physicals.
Senior services offer various programs such as arts and crafts, dancing and exercise. Rockaway Township also provides medical transportation service for residents over 55 and for the disabled. There is also a Clean Community program to keep the community a conducive living space environment. For this month, they are conducting their annual Fall Clean-Up program where residents are welcome to join other Township residents, families, youth groups, scouts and community organizations to help remove litter from parks and lake areas.
Health Behaviors and Outcomes
In New Jersey, the leading causes of death in 2016 are heart diseases (25.4%), cancer (22.4%), uninentional injury (5.2%), stroke (4.6%), diabetes (2.7%), among other causes, according to Centers for Disease Control and Prevention (CDC). The health indicator report of health insurance coverage under the U.S Census Bureau shows an upward trend of people who are insured. In the year 2016 in New Jersey, persons under the age of 65 that are insured are as follows: 95.2% among White Americans, 91% among Black Americans, and 79.3% among Hispanics. Currently, it is estimated that 87.5% of New Jersey residents have access to health care. Hispanics (75%) have lower access compared to Blacks (90%), Asians (91%), and Whites (93%). When it comes to health and wellness, New Jersey's adult obesity rate increased from 19.6% to 25.8% between 2001 and 2015. Furthermore, 14% of adults in New Jersey are current cigarette smokers. According to the 2014 NJ Youth Tobacco Survey, 8.2% of New Jersey high school students smoke. Information from Healthy New Jersey 2020 (2018) about chronic and infectious diseases show that in 2015, 18,649 New Jersey residents died of heart disease and 3,413 died of stroke. In addition, the highest incidence of syphilis, gonorrhea, and chlamydia are found among racial and ethnic minority, with the highest incidence seen among young black men and women. Young persons ages 15-24 and LGBTQ persons have high rates of STDs.
Birchwood Elementary School is one of the public elementary schools of Rockaway Township that serve students in kindergarten through fifth grade. For this school year 2018-2019, there are a total of 283 students enrolled: 81% Caucasians, 30% Hispanics/Latinos, 12% Asians, 4.9% African Americans, and the rest are “others.” The target population of this community health assessment is children who are overweight and obese. Childhood obesity is a serious problem in the United States putting children and adolescents at risk for poor health. Obesity prevalence among children and adolescents is still too high. The prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents. Data show that Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%). Non-Hispanic Asians (11.0%) had lower obesity prevalence than non-Hispanic blacks and Hispanics. It is also relevant to know that out of the 283 students, 61 students get free lunches, and 10 students get reduced price lunches. A detailed breakdown of malnourished students from Grade 1 through Grade 4 in the academic year of 2017-2018 is shown in Table 1. The CDC BMI calculator for child and teen was utilized to obtain the body max index of the students. Body Mass Index (BMI) is a person's weight in kilograms divided by the square of height in meters. It is used to find out if a person is underweight, of a normal weight, overweight, or obese. CDC states that BMI “is not diagnostic of the body fatness or health of an individual” (CDC, 2015). Nevertheless, BMI can still be an early screening tool for weightcategories that may lead to health problems according to American Heart Association (2018). The calculator that was used provides BMI and the corresponding BMI-for-age percentile based on the CDC growth charts for children and teens (ages 2 through 19 years). Girls and boys differ in their amount of body fat as they mature. This is why BMI for children, also known as BMI-for-age, includes gender and age. Obesity during childhood can have a harmful effect on the body in a variety of ways. Children who have obesity are more likely to have high blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD); increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes; breathing problems, such as asthma and sleep apnea; joint problems and musculoskeletal discomfort; fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn); psychological problems such as anxiety and depression, low self-esteem and lower self-reported quality of life, social problems such as bullying and stigma (Hales, Carroll, Fryar, & Ogden, 2016). In addition, and more importantly, if children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe (CDC, 2018). Indeed, it is important to start them young.
Health Promotion Project
Children's behaviors are largely influenced by their environment they are exposed to during their first years of life—people around them, medical care providers, faith-based institutions, media, etc. Development is very rapid during school-age years, and interventions during periods of rapid change can alter developmental pathways which can have long-term effects on the risk for obesity and related chronic disease decades later, in adulthood (Children, Birch, Burns, & Parker, 2011). Hence, it is important for all children to hear prevention messages and experience environments that support healthy behaviors.
In Birchwood Elementary School, there is a huge opportunity within their population to increase awareness about nutrition and exercise to keep a healthy lifestyle. Therefore, education will be targeted on malnourished students and people who have major influence on the children's early years, the parents. Informative discussion will be implemented with the students and education materials will be provided to the parents regarding factors of a healthy lifestyle including physical activity, healthy eating, sleep, marketing, and screen time to promote awareness and institute preventive measures for obesity.
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