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Report on the Findings of The Jewish Community Health Survey

West Rogers Park & Peterson Park

October 2006

This report was prepared by: Maureen R. Benjamins, Ph.D., Sinai Urban Health Institute

Dana M. Rhodes, M.S.W., Jewish Federation of Metropolitan Chicago Joel M. Carp, A.C.S.W., Jewish Federation of Metropolitan Chicago

Steven Whitman, Ph.D., Sinai Urban Health Institute

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Funded through the generous support of: Polk Bros. Foundation

Jewish Federation’s Fund for Innovation in Health (supported by the Michael Reese Health Trust)

Irvin and Ruth Swartzberg Foundation Fel-Pro/Mecklenburger Supporting Fund

To request additional copies, please contact: Maureen R. Benjamins, Project Director

Sinai Urban Health Institute Mt. Sinai Hospital, Rm F926

1500 S. California St. Chicago, IL 60608

773-257-2324 (phone) 773-257-5680 (fax)

[email protected]

Suggested Citation:

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Benjamins, Maureen R, Dana M. Rhodes, Joel M. Carp, and Steven Whitman. Report of the Findings of The Jewish Community Health Survey: Final Report. Chicago, IL, 2006.

To Our Colleagues: Sinai Health System and the Jewish Federation of Metropolitan Chicago have a long-standing commitment to bringing needed medical care and social services to some of Chicago’s most vulnerable communities. We take pride in our efforts to understand, reach out, and improve the overall health and well-being of the communities we serve. This is a hallmark of our shared history, which spans nearly a century. In 2000, the Sinai Health System created the Sinai Urban Health Institute (SUHI) to facilitate these efforts. Specifically, the mission of SUHI is to better understand how an individual’s living situation, community resources, and access to services all interact to help determine one’s health. To this end, SUHI recently conducted Sinai’s Improving Community Health Survey in six Chicago community areas. The information gathered by this survey revealed important community-level risk factors and some never before documented disparities in health. These findings have been used to acquire several grants to address the newly identified health problems, and to advocate for programmatic and policy changes within each of the communities. Inspired by these findings, and their potential to bring about change, the Sinai Health System and the Jewish Federation of Metropolitan Chicago expanded their existing partnership to initiate a similar survey in the most densely populated Jewish community in the city. This survey, the Jewish Community Health Survey of West Rogers Park/Peterson Park, provides detailed population-based estimates of health-related issues in this neighborhood. Based on these data, the health care providers and agencies that serve this community now have accurate estimates regarding important health behaviors, conditions, and problems with accessing services. Through these findings, we expect to bring greater resources and more effective health policies to the surveyed community. We are thus pleased to present these findings from the Jewish Community Health Survey of West Rogers Park/Peterson Park. We hope that this information will be used to improve the health of this Jewish neighborhood, as well as to provide an example for many other ethnic communities across the nation. Sincerely,

Alan H. Channing Steven B. Nasatir President and CEO President Sinai Health System Jewish Federation of Metropolitan Chicago

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Table of Contents

Executive Summary..................................................................................................................i

Introduction .............................................................................................................................1

Methodology.............................................................................................................................3

Community Characteristics ....................................................................................................6

Selected Health Topics

Topic 1: Health Status ................................................................................................10

Topic 2: Health Behaviors ..........................................................................................13

Topic 3: Health Care Access and Utilization .............................................................15

Topic 4: Overweight and Obese Adults......................................................................19

Topic 5: Overweight and Obese Children ..................................................................23

Topic 6: Depression....................................................................................................27

Topic 7: Disability ......................................................................................................30

Topic 8: Experiences with Violence...........................................................................32

Topic 9: Genetic Testing ............................................................................................35

Selected Special Populations

Population 1: Families ................................................................................................38

Population 2: Older Adults .........................................................................................42

Population 3: Low Income Households......................................................................47

Future Directions ...................................................................................................................52

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Concluding Remarks .............................................................................................................53

Executive Summary Introduction This report presents findings from the Jewish Community Health Survey of West Rogers Park and Peterson Park. This survey provides a comprehensive examination of health-related behaviors and outcomes, as well as in-depth information on health care access and utilization, for individuals living in the most concentrated Jewish community in Chicago. Although the Jewish Federation’s Metropolitan Chicago Jewish Population Study (MCJPS) conducted every ten years provides local community area data and the National Jewish Population Survey (NJPS) provides national estimates for many characteristics, this study is the first to provide detailed local-level health data for Jewish individuals in Chicago. This type of data is essential for planning targeted interventions and guiding the development of Jewish community services. The survey methodology and key findings are briefly outlined below. Methodology The data for this study was collected via face-to-face interviews with 201 Jewish adults and 58 caretakers of children. The data was collected in the Chicago community of West Rogers Park and Peterson Park (WRP/PP) between August 2003 and January 2004. A three-stage sampling design was employed to get a representative sample from these neighborhoods. Many of the survey questions were taken verbatim from national and state surveys so that comparison data would be available. In addition, topics and

questions specific to the Jewish community were added with input from key stakeholders and community leaders in WRP/PP. In total, the Jewish survey included 475 adult and 100 child questions. All of the adult frequencies are weighted to assure representativeness. Sample Demographics The mean age of the WRP/PP Jewish adult population (over 18 years of age) was 49 years, which is substantially older than both the Chicago and the U.S. adult populations. There were slightly more females than males, and 20% of the individuals in this sample were born outside of the U.S. Nearly three-quarters of the individuals were married. In addition, one-half of the respondents lived in a household with children under the age of 18. Of those with children, almost 30% had four or more. Individuals in this sample had high levels of socioeconomic status. Notably, two-thirds had a college degree or higher, and nearly one-third had a graduate degree. This exceeds the levels of education seen in the national NJPS (slightly) and in the general U.S. and Chicago populations (greatly), but is very similar to levels seen in the MCJPS. Likewise, nearly half of the sample reported a household income of more than $70,000 per year. Finally, the vast majority of Jewish individuals in WRP/PP belonged to a synagogue (81%), were Orthodox (66%), kept a Kosher home (79%), and married within the faith (96%).

Selected Health Topic Results for West Rogers Park/Peterson Park A variety of topics were given special consideration. These topics include specific health conditions, health risk factors, matters of access and utilization, and other health-related issues. The major findings regarding these topics are summarized below. Topic 1: Health Status. The majority of adults rated their own health as good or better, even though

approximately half had at least one of the most common chronic conditions. The most prevalent chronic condition was high blood pressure, which was reported by over one-quarter of adults.

Topic 2: Health Behaviors. Levels of physical activity were slightly higher than city and national estimates,

but still below recommended amounts. Relative to other groups, levels of smoking, drinking, and marijuana use were low.

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Topic 3: Health Care Access and Utilization. Most adults had health insurance and a usual place to go for

health care; they also received routine check-ups and recommended preventive services. However, almost one-quarter of the sample reported being unable to obtain certain needed medical services.

Topic 4: Overweight and Obese Adults. Over half of Jewish adults were overweight, including 25% who were

obese. Topic 5: Overweight and Obese Children. Like adults, the majority of children 2-12 years old were

overweight (54%). This includes 26% of all children who qualified as obese. Topic 6: Depression. Over one-fifth of individuals reported having been diagnosed with depression at some

point in their life. In addition, 17% were screened as currently depressed using the CES-D scale of depressive symptoms.

Topic 7: Disability. Almost one-quarter of the adults in this community lived with someone with some type

of a disability. Furthermore, nearly half of the disabled individuals reported special care needs such as therapists or mobility devices.

Topic 8: Experiences with Violence. One-quarter of adults had witnessed domestic violence and nearly one-

third reported that a member of their household had been a victim of physical, verbal, or sexual violence.

Topic 9: Genetic Testing. Within these Jewish neighborhoods, 58% of adults had never been screened for

genetic disorders. Of these, many reported not being aware of the tests, or did not consider them necessary.

Selected Special Population Highlights Three special populations within this sample were chosen because of their vulnerability to many problems, including those related to health. Important findings for each of these groups are highlighted below. Group 1: Families. Households with children were more likely to report insufficient funds for important

needs. They were also more likely to include a disabled member. Families headed by single parents were particularly at risk. Most notably, almost half were living under the poverty line.

Group 2: Older Adults. Adults over 65 years of age were relatively advantaged financially, but still faced a

disproportionate amount of health problems, including high blood pressure (63%), arthritis (65%), and activity limitations (37%).

Group 3: Low Income Households. One-tenth of adults were living under the poverty line and another 8%

lived in low-income (near poverty) households. Furthermore, almost half of the sample reported having insufficient funds for one or more of the following needs: health care, food, religious obligations, or a child’s education.

Conclusion Although the residents of West Rogers Park and Peterson Park were as healthy or healthier than their counterparts in Chicago and the U.S. for most risk factors and outcomes, the current study has identified

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several areas of concern. This type of information will be useful for developing targeted interventions to improve the health and well-being of those living in these (and similar) neighborhoods.

Introduction

Chicago has a large, and growing, Jewish population. Based on estimates from the Metropolitan Chicago Jewish Population Study (MCJPS) conducted in 2000-2001, there are approximately 270,500 Jews in the metropolitan area. While the MCJPS provides estimates on numerous topics such as general demographics and participation in Jewish activities, it does not focus on aspects of health and well-being. For this reason, community leaders felt that it was imperative to initiate a survey to determine levels of health status and health care access among Jews at a local level. Thus, the Jewish Community Health Survey was born. The idea for the Jewish study was sparked by the Improving Community Health Survey conducted by the Sinai Urban Health Institute in six Chicago community areas. These surveys provided an example of how representative samples from community areas could provide meaningful local health information to be used in developing interventions and changing policies. In contrast to data collected at the city-level, local data enables community leaders to pinpoint problems within a much smaller geographic area. Local data also allows the agencies serving these areas to better identify their clients and more accurately tailor their services. For example, smoking rates in the city of Chicago are estimated to be 23%.1 However, the Sinai Improving Community Health Survey found that this rate hides large disparities between communities, from 18% in predominantly white Norwood Park to nearly 40% in predominantly African American North Lawndale.2 Jewish leaders recognized that certain health issues may be more prevalent within the Jewish community of Chicago and began to mobilize an effort to collect similar data. A series of meetings was held with the stakeholders, community leaders, and agency professionals. Through these meetings, two neighborhoods of interest - West Rogers Park and Peterson Park - were selected because of the high concentration of Jewish individuals residing there and a hypothesized need for additional services and resources. The

Box 1. Topics Included in the Survey

Demographic and Socioeconomic Information

Education Income

Marital Status Nativity

Primary Language Spoken at Home

Physical Health Status Self-Rated Health

Chronic Conditions Disability

Mental Health Status

Quality of Life Depression

Emotional Problems Perceived Stress

Anger Management

Health Behaviors and Attitudes Substance Abuse Diet and Nutrition Physical Activity Genetic Screening

HIV/AIDS

Health Care Access and Utilization Health Insurance

Primary Care Preventive Health Care

Alternative and Complementary Treatments Prenatal Care

Religious Involvement Synagogue Membership

Denomination Keeping Kosher

Interfaith Marriage

Other Social and Environmental Factors Domestic Violence

Perceived Discrimination

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community group was also involved in the development of the survey questionnaire, which was largely based on the Sinai Improving Community Health instrument. Approximately 50 additional questions were included to focus on health and religious issues important to the Jewish population. The data collection effort was enabled through generous grants provided by the Polk Bros. Foundation and the Jewish Federation’s Fund for Innovation in Health (supported by the Michael Reese Health Trust). Additional funding for the second phase of the project (data analysis) came from the Fund for Innovation in Health, the Irvin and Ruth Swartzberg Foundation, and the Fel-Pro Mecklenberger Supporting Fund. The survey design, sampling, and interviews were done by the University of Illinois at Chicago’s Survey Research Laboratory. Work done by the Sinai Urban Health

Institute (part of the Sinai Health System) during the data collection phase was performed as “in-kind” contributions. Collecting and analyzing the data are important steps toward improving the health of these communities. However, the goal of the project will only be fulfilled if these data are used to make real changes in the lives of those living in WRP/PP. These changes can occur within numerous realms, from agency, governmental, or business policies to community-based interventions targeting individual behaviors. In addition, it is hoped that these data will be used to strengthen future grant applications dealing with health-related issues in the Jewish community. Through these pathways, the goal of improving the health and well-being of the estimated 23,000 Jews in these Chicago neighborhoods (and beyond) can be realized.

References: 1. Centers for Disease Control and Prevention (CDC). 2003. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

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2. Dell JL, Whitman S, Shah AM, Silva A, Ansell D. 2005. Smoking in 6 Diverse Chicago Communities- A Population Study. American Journal of Public Health, 95(6): 1036-1042.

Methodology

The data for this study were collected between August 2003 and January 2004 by the Survey Research Laboratory at the University of Illinois at Chicago.1 Interviews were done face-to-face using computer-assisted technology. In all, 201 Jewish adults and 57 caregivers of Jewish children were interviewed in their homes. The adult interviews took one hour, on average, while the child interview generally took 15 minutes. As a token of appreciation, respondents were given $20 for an adult interview and $10 for a child interview. More specific information on the sampling design and survey construction is provided below. Designated Study Areas The area identified by agency professionals to be the focus of the current study consists of two neighborhoods - West Rogers Park and Peterson Park. West Rogers Park is bounded by the following streets: Pulaski, Devon, Kimball, and Bryn Mawr, while Peterson Park is bounded by the following: Howard, Washtenaw, Devon, and Kedzie. These neighborhoods are part of two officially designated community areas of Chicago - West Ridge and North Park. Figure 1. Map of Chicago Community Areas

Sampling A three-stage sampling design was employed to get a representative sample from the designated communities. In the first stage, 45 census blocks were randomly selected from the two geographic areas. After the blocks were selected, interviewers recorded each housing unit on each block. This resulted in 1,719 households. In the second stage, all of the households from each of the census blocks were included. The blocks were assembled into 7 groups, to be selected at random over time as needed to reach the target sample size. In the third stage, one eligible respondent was selected at random from each household. The inclusion criteria for adults specified that they must identify themselves as Jewish, be at least 18 years of age, and live in the designated study area. Once the adult interview ended, respondents were asked if there were any children 12 years of age or younger in the household. If so, one of the children was randomly selected and the adult with the most knowledge about that child’s health was interviewed. Note that this may not be the same as the original adult respondent. Response Rates Interviews were attempted at 1,124 households. Of these, 286 were non-residential, unable to be contacted, or refused to participate. An additional 529 were ineligible. Three measures summarizing the rates of responses and refusals are described here. The response rate measures the proportion of eligible respondents who completed an interview. To calculate this, the number of eligible people who completed the interview is divided by the sum of all of those in the numerator, plus refusals, non-contact of eligibles, and a proportion of households whose eligibility status is unknown. The response rate for this survey was 50.9%.

■ = Survey

Another helpful measure is the refusal rate. This measures the proportion of eligible respondents who either refused to complete the interview or who broke off the interview. The refusal rate for the current survey is 16.6%. Finally, the cooperation rate is used to determine how many of the eligible individuals

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areas

completed an interview. Here, 75.2% cooperated. This cooperation rate is much higher than other national surveys. For example, the response rate for the 2000 NJPS was 28% and the cooperation rate was 40% (NJPS Report, 2004). The high cooperation rate in WRP/PP may be at least partially due to the efforts undertaken to make the community aware of the importance of the survey. For example, before respondents were approached by the interviewers, they first received a letter explaining the survey and the importance of this type of data for the community. These letters, which were printed on letterhead from the Jewish Community Council of West Rogers Park, were signed by leaders of the community, including the chief rabbinical judge of the Chicago Rabbinical Council. In addition, the interviewers underwent rigorous training, both in general interviewing skills, as well as in relevant aspects of the Jewish culture. Care was taken to avoid conflicts, such as asking for interviews on the Sabbath or during Rosh Hashanah. Weighting The adult frequencies are weighted in order to make the sampled population resemble the demographic characteristics of the population surveyed. In other words, the weight accounts for various differences between the sample and the population, as well as differences in the selection probabilities. The weight is equal to the inverse of the probability of selection. The child dataset is not weighted because the sample is too small. Survey Design Sinai Urban Health Institute developed the questionnaire used for this study. The instrument was adapted from Sinai’s Improving Community Health Survey, which was conducted in six Chicago community areas in 2001. Many of the questions were taken verbatim from national and state surveys so that comparison data would be available. In addition, topics and questions specific to the Jewish

community were added with input from key stakeholders and community leaders in WRP/PP. Approximately 50 new questions were added, on topics such as genetic disorders, disability, and participation in Jewish religious activities. In total, the Jewish survey included 475 adult and 100 child questions. Presentation of Results Because of the vast number of topics covered by this survey, some restraint had to be used when deciding which areas to cover in this report. The report will begin by discussing the demographic and social make-up of the communities. Once this foundation has been presented, a brief overview of the primary health measures is provided. Following this, several specific areas of concern are highlighted. Finally, the report ends with three sections on vulnerable populations within these communities. Whenever possible, results from WRP/PP will be compared to other populations. Specifically, comparable data from the Metropolitan Chicago Jewish Population Study (MCJPS), the National Jewish Population Survey (NJPS), the Chicago Behavior Risk Factor Surveillance System (BRFSS), the U.S. Census, and other national surveys are provided (when available). Background information on the MCJPS and the NJPS is summarized on the following page All results shown in this report are representative of Jewish adults over the age of 18 (or children, if noted) living in the explicitly defined areas of West Rogers Park and Peterson Park. The estimates provided by this scientifically selected sample can not be extrapolated to other populations, such as all Jews in the U.S., residents of Chicago, or even Jewish residents of Chicago (see the MCJPS for this). Furthermore, although the Jews living in the selected neighborhoods are primarily Orthodox, the WRP/PP estimates reflect all Jews in these areas, not only those reporting an Orthodox affiliation.

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Metropolitan Chicago Jewish Population Study (MCJPS) The MCJPS is a survey of Jewish individuals living in the Chicago Metropolitan area. Funded by the Jewish Federation, this survey is conducted every ten years. In the current report, data from 2000-2001 is used to provide local Jewish comparisons. In the MCJPS 2000-2001, 2,048 Jewish adults were chosen from randomly selected households from a six county area of Northeast Illinois (including Cook, Lake, DuPage, McHenry, Will, and Kane counties). Once it was established that there was at least one Jewish adult in the household, a telephone interview was conducted with the randomly selected adult. Questions from previous Metropolitan Chicago Jewish Population Studies, as well as from the NJPS, were used in the current MCJPS to facilitate comparisons. Topics covered included demographic characteristics, social service needs, Jewish connections and values, Jewish education, ancestry, and residential mobility. National Jewish Population Survey (NJPS) The NJPS is a representative survey of the Jewish population in the U.S.2 It was established in 1971 to provide information to community leaders and organizations on topics including intermarriage, participation in Jewish organizations and activities, immigrants, the elderly, philanthropy, and regional differences, among others. In 1990 and 2000, additional surveys were fielded to provide updated information. These surveys were sponsored by United Jewish Communities and the Jewish Federation system. Some controversy arose when the findings of the 2000-2001 survey were first publicized. This debate primarily centered on the new criteria used for identifying Jews and the population size estimated from their data (5.2 million Jews in the U.S.). Part of the difficulty in assessing the validity of this data has been the lack of comparable data sets. While the sample from the current study differs both in selection criteria and representative nature (national vs. regional), it is used as a comparison because it is the only nationally representative data for American Jews. References: 1. Survey Research Laboratory. 2004. Community Health Survey of West Rogers Park: Final Methodological Report. University of Illinois at Chicago, Survey Research Laboratory, Project #951.

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2. United Jewish Communities. National Jewish Population Survey 2000-01: Strength, Challenge and Diversity in the American Jewish Population. A United Jewish Communities Report, in Cooperation with the Mandell L. Berman Institute and the North American Jewish Data Bank. January 2004.

Community Characteristics An overview of the demographic, socioeconomic, and religious characteristics of the Jewish Community Health Survey is presented here. All findings in this section are for the adult sample and all estimates are weighted. Demographic Characteristics Age. Age distributions show that the Jewish populations in West Rogers Park/Peterson Park (WRP/PP) and in Chicago tend to be older than the general U.S. adult population (see Figure 1). For the Jewish populations, fewer individuals fell into the 18-44 year age ranges and more were 45-54 years of age or 75 years and older. It is important to note that approximately 20% of Jewish adults in WRP/PP and Chicago were over 65 years of age. This is greater than the overall national estimates (17%), but slightly lower than national Jewish estimates (24%). The mean age of the WRP/PP adult population was 49.3 years. Gender. The gender distribution shows that the population represented by the current survey included slightly more females than males (52% vs. 48%). These numbers are similar to the MCJPS and U.S.

Census estimates, while in the national Jewish population there were even more females (see Table 1). Nativity. Twenty percent of the individuals in this sample were born outside of the U.S. The majority of these were born in the former Soviet Union or Israel. Significantly fewer individuals in the Jewish populations of Chicago or the U.S. are immigrants, compared to this. And, in general, this percent of immigrants is almost double the overall U.S. estimate. Socioeconomic Status Education. Individuals in this sample were highly educated. Notably, only 10% had a high school diploma or less. Two-thirds had a college degree or higher, and nearly one-third had a graduate degree. This exceeds the levels of education seen in the national NJPS (slightly) and in the U.S. and Chicago (greatly). For example, the percentage of individuals in WRP/PP with a graduate degree is three times higher than the national average. The levels of education seen in WRP/PP are very similar to those in the MCJPS.

Figure 1. Age Distributions of WRP/PP, Chicago Jewish Population, and U.S. Adults

0

5

10

15

20

25

30

35

18-24 25-34 35-44 45-54 55-64 65-74 75+

Age Category (in years)

Perc

ent WRP/PP

MCJPSUS

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Source: Jewish Community Health Survey, 2003; MCJPS, 2000-2001; and the 2000 Census

Table 1. Comparison of Demographic and Social Characteristics ab WRP/PP

(%) MCJPS

(%) NJPS (%)

Chicago c

(%) U.S. c

(%) Gender Female Male Nativity US born Foreign born Education Some college or less College degree Graduate degree Annual household income

Less than $25,000 $25,000-$74,999 More than $75,000 Employment status Employed

52 48

80 20

35 38 27

14 d

38 47

60

52 48

87 13

31 41 29

14 44 43

64

56

44

85 15

45 30 25

22 44 34

61

51 49

78 22

74 16 10

33

47 20

61

51 49

89 11

75 16 9

29 48 23

65

Notes: a Weighted data, N=201 for current survey b Percentages may not add to 100 due to rounding c Census, 2000. Age ranges vary slightly. Specifically, education is asked of adults ≥ 25 and employment status for those ≥ 16. All others reflect adults ≥ 18 years.

d Income categories differ for the current survey. They are as follows: Less than $30,000, $30,000-$69,999, and More than $70,000

Annual Household Income. Like education, individuals in the current survey also had relatively high incomes. For example, nearly half of the sample reported a household income of more than $70,000 per year. This is substantially higher than levels in the national Jewish estimates, Chicago, and the U.S. At the other end of the spectrum, fewer respondents in the current survey had a household income of less than $30,000 per year, compared to most other estimates. Like education, the income distribution in WRP/PP is similar to that seen in the MCJPS sample. It is important to note, however, that the estimates for the MCJPS, NJPS, and Census reflect different income categories. Specifically, these surveys use the following categories: less than $25,000, $25,000-$74,999, and more than $75,000, while the current survey uses the following: less than $30,000, $30,000-$69,999, and more than $70,000. For this reason, the true estimates are apt to be slightly more similar than they appear. It is also important to consider differences in average family size. As discussed below, families in WRP/PP tend to be larger and, thus, the “per capita” income levels would be lower. In other words, the

financial situation of this population may not be as favorable as the income data suggests. Employment Status. In this sample, 60% of the individuals were currently employed. This estimate is very similar to that of the NJPS and Chicago (both at 61%) and just slightly below national and MCJPS levels. Family Structure Marital Status. Substantial differences are seen within marital status (see Table 2). In the current sample, nearly three-quarters of the individuals were married. Thirteen percent had never been married and only small percentages were either widowed or divorced/separated. Compared to national and city Jewish estimates and the U.S. population, Jews in the current survey were much more likely to be married and approximately half as likely to be single/never married.

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Household Size. Only 10% of individuals in WRP/PP lived alone. This estimate is much lower than those for the national Jewish population or the U.S. population. In fact, data from the MCJPS and NJPS shows that three times as many Jews live alone

Table 2. Comparison of Family Structure Characteristics WRP/PP

(%) MCJPSa

(%) NJPSb

(%) U.S.c

(%) Marital status Married Widowed Divorced/separated Never married Family structure Lives alone Children in household

73 7 7

13

10 50

57 9

11 23 d

27 31

57 8

10 25

30 26

54 7

12 27

26 e

35 f

Notes: a MCJPS, 2000-2001 b NJPS, 2000 c U.S. Census data; marital status is asked of those ≥ 15 years of age d Includes 3% of sample who are currently living with someone e Reflects households, not individuals f Data only available for related children

in Chicago and nationwide. At the other end of the spectrum, the current study finds that over one-third of individuals lived in a household with five or more total occupants (not shown). Compared to this, the percentage of adults in the U.S. living in households this large is much smaller (10%). Children. One-half of the respondents in WRP/PP lived in a household with at least one child (under 18 years). Households with children were much less common in the MCJPS, NJPS, and U.S. estimates. Individuals in the current survey also tended to have

more children (see separate section on families for more details). Other Family. Two additional questions were asked regarding the presence of other family members (not shown). Just over 10% of individuals in WRP/PP shared a household with their parents or in-laws. In addition, 83% of the sample had other family members living within 25 miles. Religious Characteristics Adults living in WRP/PP showed high levels of

Figure 2. Synagogue Affiliation of Jewish Adults

0

10

20

30

40

50

60

70

80

Orthodox orTraditional

Reform Other

Perc

ent WRP/PP

MCJPSNJPS

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Source: Jewish Community Health Survey, 2003; MCJPS, 2000-2001; NJPS, 2000

Table 3. Religious Characteristics Among Adults

WRP/PP a (%)

MCJPS b

(%) NJPS c

(%) Member of synagogue Keeps a Kosher home Jewish spouse (if married) Received Jewish services in past year Income insufficient for religious obligations

81 79 96 28 25

42 20 82 -- 35

46 21 69 -- --

Notes: a Weighted data b MCJPS, 2000-2001 c NJPS, 2000

religious involvement. For example, a substantially higher percentage of individuals in the current study belonged to a synagogue, compared to national estimates of the Jewish population (see Table 3). Of the synagogue members, individuals were much more likely to belong to Orthodox traditions compared to other Jewish populations (see Figure 2). More specifically, two-thirds of Jewish individuals in WRP/PP who belonged to a synagogue belonged to an Orthodox one (66%). This is in sharp contrast to the MCJPS and NJPS estimates, which show more balanced memberships in Orthodox, Conservative, and Reform synagogues. These differences are substantial; for example, the percentage belonging to Reform synagogues is more than six times higher in the national and Chicago estimates compared to WRP/PP. Other measures of Jewish connections include keeping a Kosher home and intermarriage, as shown in Table 3. In the current sample, the majority reported keeping a Kosher home. This rate was nearly four times the levels seen in the Chicago and

national Jewish surveys. Rates of within-faith marriage were also higher in the current study. Here, nearly all of the married individuals had Jewish spouses, while the national survey found that approximately two-thirds of Jews married within their faith. Rates of intermarriage for the Chicago Jewish population were in between the WRP/PP and national estimates. Markers of other issues specific to Jewish communities showed that that over a quarter of the respondents reported that they had received services from Jewish-affiliated agencies in the past year. In addition, one-quarter of the sample reported that their income was insufficient to meet their religious obligations. This percent can be compared to the percent of adults who responded affirmatively to a similar, but broader, series of questions in the MCJPS. In that survey, 35% of individuals reported that cost prevented them from certain religious obligations, including belonging to a synagogue, keeping Kosher, belonging to a Jewish Community Center (JCC), or going to Israel.

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Selected Topic 1: Health Status In this section, the general health status of the residents of WRP/PP is reviewed. In particular, subjective ratings of health and the presence of chronic conditions are examined. Self-Rated Health The first measure of overall health status was determined with a question that asked respondents, “In the last 12 months, would you say your health in general has been excellent, very good, good, fair, or poor?” This measure, often called self-rated health, is a commonly used indicator of health status because it is strongly predictive of mortality risk, even after accounting for other risk factors such as age, low education and income, high blood pressure, obesity, and other measures of health status.1 In other words, individuals who report that their health is poor are more likely to die in a given period compared to individuals who say their health is good, even if these two individuals have the same number of health problems. Using this global measure of health status, it was found that the vast majority of adults in WRP/PP considered themselves to be in “good” health or better (see Table 1.1). Just over one-quarter were at the highest end of the scale (“excellent”), while only 5% said they had “poor” health. Although WRP/PP (and the other Jewish populations) had slightly more individuals in the top category compared to general city and national samples, all of the groups had fairly similar distributions.

Chronic Conditions Another important indicator of health and well-being, particularly for adults, is the prevalence of chronic conditions. Although subjective ratings of health are strongly associated with having certain chronic conditions, many individuals living with chronic conditions still consider themselves to be in good health. Thus, it is important to look at more than one measure of health status to get an overall picture of well-being. Six of the most common conditions were ascertained and compared with national and local estimates. (Few health questions were asked of Jews nationwide or in Chicago. Therefore, most of the comparison data for this area will come from the Census and other national surveys.) When adjusted for age, the first finding shows that over one-quarter of the Jewish sample from WRP/PP reported a diagnosis of hypertension (see Table 1.2). This is slightly higher than the percentages seen in the Chicago and national sample. Hypertension, also known as high blood pressure, is important to study because it is one of the leading causes of cardiovascular morbidity and mortality in the U.S. It also increases an individual’s risk of other health problems such as stroke and kidney failure. Fortunately, once detected, many simple changes (such as eating a healthy diet, exercising regularly, not smoking or drinking, and/or taking medication) can reduce the risks related to this

Table 1.1. Self-Rated Health Status ab

WRP/PP

(%) MCJPS

(%) NJPS (%)

Chicago c

(%) U.S. c

(%) Self-rated health Excellent Very good Good Fair Poor

26 28 25 15 5

33 29 24 10 3

42 d

-- 40 13 5

20 30 34 12 4

22

34 29 11 4

Notes: a Weighted data; N=201 b Percentages may not add to 100 due to rounding c Behavioral Risk Factor Surveillance System (BRFSS), 2003

10

d Only four response choices given

Table 1.2. Prevalence of Chronic Conditions WRP a

(%) Chicagob

(%) U.S. c

(%) Conditions Hypertension Diabetes Cancer Heart problems Arthritis Asthma Any of these

28 7 7

13 25 10 51

25 8 -- -- -- 11 --

21

7 7

11 21 11 --

Notes: a Weighted data; N=201; age-adjusted rates b 2002 and 2003 BRFSS data for Cook County, IL c National Health Interview Survey (NHIS), 2002 condition.2 Unfortunately, the Centers for Disease Control and Health Promotion (CDC) estimate that nearly one-third of all cases of high blood pressure are undetected. This means that the rates seen here are likely to greatly underestimate the number of individuals with unhealthy blood pressure levels (for all groups). Levels of other chronic conditions, including diabetes, cancer, and asthma, were similar to national and local estimates. For all of these, less than 10% of the adult population had been diagnosed with the condition. Larger percentages of individuals reported having arthritis and heart problems. Again, both of these rates are comparable to national estimates. Overall, just over half of the adults reported having at least one of these six conditions. The prevalence of other chronic conditions was also assessed (not shown here). Particular attention was paid to diseases that are often more prevalent in Jewish populations. However, the majority of these

diseases, and others, were reported by so few respondents that reliable estimates could not be produced. For example, less than 5% of the sample reported being diagnosed with Crohn’s Disease, colitis, Hepatitis B or C, tuberculosis, or bi-polar disorder. Although levels of many of the chronic conditions shown in Table 1.2 were comparable to national estimates (and affected fairly small percentages of individuals), it is important to pay attention to these rates for several reasons. For one, rates of conditions like diabetes were low, but may be growing rapidly. As discussed later in this report, levels of obesity in this population are high (even among young children), and it is well established that being overweight is a major risk factor for diabetes (as well as other chronic conditions, such as high blood pressure and heart problems). Thus, the prevalence of these conditions is likely to increase in this population in the coming years. In addition, having chronic condition rates equal to those seen for the country as a whole is not necessarily an impressive accomplishment. For many measures of health, the U.S. routinely ranks at the bottom of all industrialized countries. For example, the average life expectancy at birth for the U.S. is only the 48th highest in the world.3 Finally, the community should not be satisfied with the current levels of chronic conditions because these conditions significantly affect an individual’s quality of life, yet a large percentage are due to preventable causes. Thus, continually lowering the prevalence of these conditions is a reasonable, and worthy, goal for all communities.

11

Conclusions and Implications Although the majority of individuals in this sample rated their health very positively, one-fifth of adults reported that their health was only fair or poor. At least part of this negative rating is probably due to the presence of chronic conditions. The high levels of certain chronic conditions seen here, such as high blood pressure, should be noted by health care providers and public health officials serving this population, as well as by the community members themselves. For most chronic conditions, interventions can be designed to have an effect at several stages, including prevention, diagnosis, and treatment. Examples of changes that can be made to prevent the onset of future conditions include efforts to increase levels of physical activity and improve diets. There are also numerous interventions aimed at increasing the detection and diagnosis of chronic conditions. For blood pressure, interventions might include placing more blood pressure testing machines in the community, offering free blood pressure screenings at community centers, and providing classes on how to take and interpret blood pressure scores. Finally, individuals who already have a chronic condition may need more information on how to manage their diseases with healthy lifestyle choices, medication, or other activities. Support groups and lecture series are just two examples of offerings that may help individuals to take control of their health. It is possible that many of these educational activities could be offered through synagogues or other community agencies. References: 1. Idler EL, Benyamini Y. 1997. Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies. Journal of Health and Social Behavior, 38: 21-37. 2. National Heart, Lung, and Blood Institute website. 2005. Your Guide to Lowering High Blood Pressure. Retrieved from: http://www.nhlbi.nih.gov/hbp/index.html. Retrieved on: September 22, 2005.

12

3. World Fact Book. 2005. Rank Order: Life Expectancy at Birth. CIA Publications. Retrieved from: http://www.cia.gov/cia/publications/factbook/rankorder/2102rank.html. Retrieved on: September 23, 2005.

http://www.cia.gov/cia/publications/factbook/rankorder/2102rank.html

Selected Topic 2: Health Behaviors

Due to the increasing awareness of the role that health behaviors play in maintaining wellness, numerous questions were asked to gauge the level of behavioral risk factors in this population. In this section, levels of physical activity, smoking, drinking, and drug use are summarized. Physical Activity Respondents were asked about levels of both moderate and vigorous physical activity. Examples that were given to define moderate activities included brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breathing or heart rate. Examples of vigorous activities included running, swimming laps, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate. For each level, respondents were asked how many times per week they engaged in the activities for at least 20 minutes at a time. It is generally recommended that adults engage in moderate physical activities for at least 30 minutes on 5 or more days of the week.1-2 In addition, Healthy People 2010, a collection of health goals for the U.S., recommends that individuals engage in vigorous physical activity 3 or more days per week for 20 minutes or more at a time. 2 Meeting either (or both) of these goals has been shown to provide individuals

with extensive health benefits. Unfortunately, in WRP/PP, levels of both moderate and vigorous activity fell below recommended amounts of exercise (see Table 2.1). Approximately one-half of individuals participated in moderate activities and one-quarter in vigorous activities three or more times a week. These levels are both slightly higher than Chicago averages, but similar to those for the U.S. Some differences in activity levels exist when looking at demographic and socioeconomic characteristics (not shown). For example, women were significantly more likely to report regular moderate exercise, but were slightly less likely to report participating in vigorous activities. Although no differences are seen for education, individuals with lower incomes were less likely to report moderate exercise, compared to those who earn more. Finally, foreign-born individuals have much lower levels of physical activity for both moderate and vigorous intensities. Many of these trends are similar to those seen in other populations.2 Substance Use Cigarettes. On a more positive note, questions regarding cigarette use found that only 4% of the sample reported being a current smoker. In

Table 2.1. Comparisons of Selected Health Behaviors WRP/PP a

(%) Chicago b

(%) U.S. c

(%) Physical activity Moderate activities (≥ 3 times/week) Vigorous activities (≥ 3 times/week) Cigarette use Current smoker Former smoker Alcohol use Current drinker (≥ 1 drink in last month) Drug use Smoked marijuana in past month

50 27

4

30

48

4

43 22

23 23

60

7 d

47 25

22 25

59

6 d

Notes: a Weighted data; N=201 b BRFSS, 2002, 2003 c BRFSS, 2003

13

d National Survey on Drug Use and Health, 1998, 2001

comparison, 23% of individuals in Chicago and 22% of the general U.S. population currently smoke. Interestingly, the percentage of individuals who had smoked in the past was slightly higher for the WRP/PP sample. Note that a social desirability bias may result in individuals underreporting their actual smoking levels. This may be particularly true in a predominantly Orthodox community where rules (and norms) prohibiting smoking exist (such as explicitly prohibiting smoking on the Sabbath). Although these findings are likely to underestimate the actual level of smoking in this community, the bias towards underreporting is thought to occur (to some extent) in all populations. Thus, actual levels of smoking in WRP/PP are likely to be higher than seen here, but still lower than other populations. Alcohol. It was also found that approximately half of the adults in WRP/PP consumed alcoholic beverages in the past month. This level is lower than both the

Chicago and U.S. population estimates. Further analyses showed that the vast majority of these “drinkers” had one drink or less per week, on average. A series of questions was also asked to assess the prevalence of drinking problems. These questions concerned topics such as feeling guilty about drinking, drinking in the morning, drinking and driving, and being advised by a doctor to stop drinking. For each of these questions, no more than 3% of the sample reported a problem. Marijuana. Finally, only 4% of the adults reported smoking marijuana in the past month. This rate is slightly lower than Chicago or U.S. rates. No additional questions on drug use were included here. Other Health Behaviors Other important health behaviors are discussed throughout the following sections of this report. For example, genetic screening, efforts related to weight loss, and the use of preventive services will all be covered.

Conclusions and Implications Adults in WRP/PP appear to have few problems in the area of substance abuse. This is not to say that problems with drinking, smoking, or drugs do not exist; rather, the results simply indicate that the problems are relatively modest, both in terms of the number of individuals affected and in comparison to other populations. However, the findings discussed here do indicate that this population has at least one risky healthy behavior- a sedentary lifestyle. The results show that approximately half of the sample did not meet the minimum recommendations for physical activity. Most individuals are aware of the positive benefits of exercise, so providing an environment conducive to physical activity is one of the most effective means of promoting this healthy behavior. There are numerous ways for a community to facilitate physical activity. For example, communities can work to provide safer and more accessible walking and biking trails. Businesses and schools can create lunchtime walking groups. Community centers can increase the number and variety of classes offered that teach enjoyable forms of activity, such as Israeli dance or martial arts. Beyond these community options, families are another key area on which to focus. Encouraging parents to engage in family activities that require physical exertion benefits everyone’s health. Ideas for family activities include walking together after dinner, taking a Sunday bike ride, or playing catch or frisbee in the yard. References: 1. Centers for Disease Control and Prevention website. Physical Activity for Everyone: Recommendations. Retrieved from: http://www.cdc.gov/nccdphp/dnpa/physical/recommendations/index.htm. Retrieved on October 4, 2005.

14

2. Healthy People 2010 website. Leading Health Indicators. Retrieved from: http://www.healthypeople.gov/Document/html/uih/uih_bw/uih_4.htm#physactiv. Retrieved on October 4, 2005.

http://www.cdc.gov/nccdphp/dnpa/physical/recommendations/index.htm

http://www.healthypeople.gov/Document/html/uih/uih_bw/uih_4.htm#physactiv

Selected Topic 3: Health Care Access and Utilization Access to health care services, as well as the appropriate use of these services, is strongly linked to many health outcomes. Although issues such as a lack of health insurance and an inability to afford the rising costs of health care are plaguing the United States as a whole, little is known about the health care needs of the Jewish population. This section will focus on the presence of health insurance, the ability to afford health care services, and the use of various health care services by Jews living in WRP/PP. Where available, national rates will be cited for comparison. Health Insurance Almost all adults in the WRP/PP sample reported having health insurance, regardless of age (Figure 3.1). As expected, levels of private health insurance were lower for all groups. However, almost all adults under 65 years of age in the Jewish sample had private insurance, compared to only 70% of adults in the national sample. Of older adults, about half had private insurance, which is slightly less than the national average.

Figure 3.1. Rates of Health Insurance

0

20

40

60

80

100

18-64years

65 years 18-64years

65 years

Any Private

Perc

ent

WRP/PPUS

Source: U.S. data comes from CPS, 2001; BRFFS, 2003; and NHIS, 2002

Table 3.1. Access to Health Care

WRP/PP a

(%) U.S. (%)

Did not get care when needed (any type) Medical care or surgery Prescription medications Mental health care Dental care Eyeglasses

23 9 7

10 11 7

--

10 b

7 c

-- 10 c

-- Notes: a Weighted data; N=201 b BRFSS, 2000 c NHIS, 2001 Access to Health Care The percent of individuals who reported not getting the services that they needed provides additional insight into how well individuals can access health care (see Table 3.1). In this sample, nearly one-quarter of respondents reported not getting some type of health care when they needed it (this includes medical care, prescription medications, mental health care, dental care, and eye care). The percentage of adults in WRP/PP not getting specific types of needed care was similar to levels seen in national data (when available). Respondents were asked about this issue in another way as well. Specifically, they were asked, “Do you feel that your family income is sufficient or insufficient to meet your current health needs, irrespective of health insurance?” In response, 28% reported that their income was insufficient to meet their health care needs (not shown). Utilization of Health Care

15

Numerous questions were asked regarding the individuals’ use of various health care services (see Table 3.2). To begin, nearly all adults reported having a “particular clinic, doctor’s office, or health care facility” that they usually go to when sick or seeking advice about health. Also referred to as having a “usual source of care,” this is an important issue to examine because it is correlated with better health outcomes, greater use of preventive services, and reduced medical costs, among other things.1-3

Table 3.2. Aspects of Health Care Utilization WRP/PP a

(%) U.S. (%)

Usual source of care Gets routine check-ups Visited doctor in the past year Visited hospital in the past year

90 70 89 32

84 b

65 c

68 c--

Notes: a Weighted data; N=201; b NHIS, 2001; For adults 18-64 years of age c Medical Expenditure Panel Survey (MEPS), 2002 Fortunately, almost all adults in WRP/PP reported having a usual source of care. This estimate (90%) was slightly higher than levels seen for all adults in the U.S. Likely facilitated by this, the majority of adults reported getting regular check-ups with their physician. Adults in WRP/PP are slightly more likely to do so than adults in the U.S. as a whole. Those living in WRP/PP are also more likely to have visited a physician in the past year. Almost all adults reported such a visit. In addition, nearly one-third visited a hospital in the past 12 months. Unfortunately, comparable data could not be found for this. Utilization of Preventive Services Individuals in the Jewish Community Health Survey reported high levels of preventive service utilization for almost all types of services (see Table 3.4). For example, most individuals (88%) had their blood pressure screened in the past year. This is likely to be similar to rates of screening in national samples, which are measured within the past two years here. Approximately half of the current sample reported

ever having a colonoscopy (or sigmoidoscopy) and a blood stool test. These numbers are both slightly higher than local and national averages. For female services, large percentages of women in the appropriate age ranges reported regular mammograms and Pap smears (80% and 89%, respectively). These numbers are both higher than national averages, but similar to Chicago estimates. Men in this sample, on the other hand, show lower than average rates of screening for prostate-specific antigen (PSA) tests. While over half of the men in the national sample reported having this test in the past year, only 36% of the men in the current sample did. Alternative and Complementary Treatments The use of complementary and alternative medicine (CAM) has grown significantly throughout the past decade. As evidence of this, the National Institute of Health established the National Center for Complementary and Alternative Medicine in 1998 to study these non-Western treatments. High levels of CAM use are seen in the current sample, where almost half of adults have visited at least one type of alternative care provider (see Figure 3.2). This level is similar to those seen in the most recent national study, which found that approximately 37% of adults have used some form of CAM (not including prayer) at some point in their lives.4 Certain types of CAM treatments are used more frequently by those in WRP/PP. For example, while only 20% of adults in the U.S. have ever been to a chiropractor, over one-third of those in WRP/PP have done so. Similarly, nationwide, only 4% of adults

Table 3.4. Preventive Health Care Utilization

WRP/PP a

(%) Chicago b

(%) U.S. (%)

Blood pressure test (all, in past year) Colonoscopy or sigmoidoscopy (≥50, ever) Blood stool test (all, ever) Mammogram (females, ≥40, past 2 years) Pap smear (females, past 3 years) PSA (males, ≥50, ever)

88 52 51 80 89 36

-- 46 41 80 88 --

95 c

37 d

45 e 70 e

81 d

57 d

Notes: a Weighted data; total N=201, but sample size varies by item b Data is for Cook County from the BRFSS, 2002 and 2003 c In past 2 years; BRFSS, 1999 d NHIS, 1998, 2000 e BRFSS, 2000, 2002

16

Figure 3.2. Use of Complementary and Alternative Treatments in WRP/PP

0

10

20

30

40

50

Any Chiropractor Acupuncturist Herbalist Holistic Healer Midwife

Perc

ent

Source: Jewish Community Health Survey, 2003 have used acupuncture, compared to 14% of those in WRP/PP.4 In addition, individuals were asked if they were taking any type of herbal medications. In the current survey, 13% reported they were. This is

comparable to national estimates, which indicate that nearly 20% of adults have taken herbal medicine at some point in the past year.4

Conclusions and Implications This survey provides the first assessment of how members of this Jewish community access and utilize health care services. Many positive findings are evident. For example, most adults had health insurance and a usual place to go for care, and they received routine check-ups. They also reported having most recommended preventive services; however, rates for certain tests, such as those for prostate and colon cancer, have room for improvement among adults in the target age ranges. Educational campaigns to foster awareness about the importance of screening for these diseases may increase the number of adults obtaining these preventive services. The findings also serve to highlight one set of important problems faced by adults in WRP/PP. Specifically, almost one-quarter of the sample reported being unable to get certain medical services they needed. Community agencies need to work together to address this complex problem. Efforts must be made to provide funds for individuals unable to pay for uncovered services, co-payments, and deductibles. In addition, because the inability to get needed care may not be simply due to a lack of money, care must be taken to ensure that services exist to help individuals to get to medical facilities. For example, having a community medi-cab service may allow individuals, especially those who are sick or who have other limitations, to get to the health care provider. Also, providing childcare on set days at community centers or synagogues may allow parents the time to take care of their own health. Finally, different medical services may be inaccessible for different reasons, and possible interventions must take this into account. For example, dental care is often not covered by insurance plans. Finding a way to allow individuals get yearly check-ups and cleanings would result in significant long-term cost savings, as well as improved quality of life for those who could avoid more serious procedures through this type of preventive care. In addition, individuals may not get needed mental health services because of the stigma attached to this type of illness. Educating the community on the prevalence, and treatable nature, of many mental health problems may increase the use of these types of services. In conclusion, the various agencies that serve this population should be encouraged to work together to help individuals access needed medical care.

17

References: 1. De Maesneer JM, De Prins L, Gosset C, and Heyerick J. 2003. Provider Continuity in Family Medicine: Does it Make a Difference for Total Health Care Costs? Annals of Family Medicine, 1(3): 144-148. 2. DeVoe JE, Fryer GE, Phillips R, and Green L. 2003. Receipt of Preventive Care Among Adults: Insurance Status and Usual Source of Care. American Journal of Public Health, 93(5): 786-791. 3. Starfield B and Shi L. 2004. The Medical Home, Access to Care, and Insurance: A Review of the Evidence. Pediatrics, 113(5): 1493-1498.

18

4. Barnes P, Powell-Griner E, McFann K, and Nahin R. Complementary and Alternative Medicine Use Among Adults: United States, 2002. CDC Advance Data Report #343. May 27, 2004.

Selected Topic 4: Overweight and Obese Adults

The factors leading to obesity – poor diet and physical inactivity – are now the second leading cause of preventable deaths in the United States.1 In addition to lowered life expectancy, being overweight or obese is a major risk factor for a wide variety of health outcomes, including diabetes, heart disease, stroke, and impaired mobility, as well as social and emotional problems.2,3 To classify individuals into weight categories, a measure called the body mass index (BMI) is used. BMI is calculated with a formula that uses an individual’s weight and height [703*(weight in pounds)/(height in inches)*(height in inches)]. Using this measure, individuals are classified as follows: underweight (BMI<18.5), normal (18.5≤ BMI<25), overweight (25≤ BMI<30), or obese (BMI≥ 30). Throughout this report, the few underweight individuals will be classified as normal. In WRP/PP, nearly one-third of the adults (31%) were overweight and an additional one-quarter were obese (see Figure 4.1). Although the percent of normal weight individuals is slightly better than the national and city averages, weight still represents a major problem in that over half of the adults in this community weigh too much. Health Status In order to highlight the negative consequences of

Figure 4.1. Adult Weight Status

05

101520253035404550

WRP Chicago U.S.

Perc

ent

NormalOverweightObese

Source: Jewish Community Health Survey, 2003; BRFSS, 2002 being overweight, Figure 4.2 shows how increased weight is associated with a greater prevalence of various health conditions. Not surprisingly, overweight and obese individuals had a much higher likelihood of having been diagnosed with chronic conditions such as heart disease, hypertension, and diabetes. The percent of individuals with high blood pressure is particularly striking. For instance, over half of obese individuals had this condition, compared to only 19% of normal weight individuals. In addition, overweight and obese individuals were more likely to rate themselves in fair or poor health. While only 10% of normal weight individuals

Figure 4.2. Health Problems by Weight Status

0

10

20

30

40

50

60

Heart Disease Hypertension Diabetes Fair or PoorSubjective

Health

Depression

Perc

ent Normal

Overwt.Obese

19

Source: Jewish Community Health Survey, 2003

Table 4.1. Perceived Versus Actual Weight Statusa

Actual weight status Normal

(%) Overweight

(%) Obese (%)

Perceived status Normal weight Slightly overweight Very overweight

68 31 0

19 70 11

0

30 70

Notes: a Weighted data, N=201; Percentages may not add to 100 due to rounding

reported that their overall health was fair or poor, two to three times this percent of overweight and obese individuals said so. Similarly, overweight and obese individuals were two to three times more likely to screen positive for depression. To better understand the factors leading to obesity, numerous related topics are examined here, including perceived weight status, weight loss efforts, eating habits, and grocery shopping information. Perceived Weight Status In addition to providing their weight and height, individuals were also asked to rate their own weight (see Table 4.1). The exact question was: “Do you consider yourself currently to be very overweight, slightly overweight, slightly underweight, very underweight, or about the right weight?” These

correspond to the BMI categories of obese, overweight, and normal/underweight. The majority of individuals in each BMI group correctly identified their status; however, almost a third of individuals did not. This is most important for those who are overweight and obese. For overweight individuals, 19% said that they were “about the right weight.” For obese individuals, 30% said they were only slightly overweight. Underestimating one’s BMI is dangerous for several reasons. For one, these individuals may have a decreased awareness of the seriousness of the health risks they are exposed to because of their weight. In addition, an incorrect perception may result in lower levels of motivation for losing weight. Other Weight-Related Issues Advice from Doctor. Physicians may play an important role in both creating awareness of weight problems and providing safe and effective information about weight loss methods. Unfortunately, not all overweight and obese individuals received advice from their doctors regarding their weight problem. In fact, only 28% of overweight individuals and only 54% of obese individuals were advised to lose weight (Table 4.2). As found in previous studies, overweight and obese

Table 4.2. Weight-Related Issues a

Normal (%)

Overweight (%)

Obese (%)

Advice from doctor b

Any advice about weight in past year Advice to lose weight Desired weight Currently trying to lose weight Currently trying to maintain weight Not trying to lose or maintain weight Current weight loss efforts Eating fewer calories or less fat only Exercising only Both eating healthier and exercising Neither eating healthier nor exercising Eating habits Satisfied with eating habits Considers diet/nutrition very important Eats too much at meals most or all of time Eats fast food once a week or more

11 4

20 58 22

3 3

12 81

80 60 4

23

32 28

66 27 7

17 16 32 34

62 78 9

23

58 54

85 12 3

22 19 35 24

34 61 16 50

Notes: a Weighted data; n=201

20

b Only includes individuals with visit to doctor in past yr (n=180)

Figure 4.3. Reasons for Not Eating Healthier

0

10

20

30

40

50

60

Doesn't want to giveup favorite foods

Too much effort tocook healthy

Doesn't understandnutrition guidelines

Nutritious foods aretoo costly

Perc

ent

Source: Jewish Community Health Survey, 2003 Note: Only asked of individuals not satisfied with their eating habits, N=74 individuals who reported receiving weight loss counseling from their physician were more likely to be trying to lose weight than those who did not receive counseling (data not shown).4,5 Desired Weight and Weight Loss Efforts. As alluded to above, many overweight and obese individuals were not trying to lose weight. In fact, one-third of overweight individuals reported that were not currently trying to lose weight. Of these, the majority reported that they were trying to maintain their current weight. For obese individuals, 15% were not trying to lose weight. Those that were trying to lose weight reported using different methods. For example, approximately one-third of both groups were eating healthier and exercising. Smaller percents were using one strategy or the other. Eating Habits. The percent of individuals satisfied with their current eating habits has an inverse relationship with BMI. Individuals who are not overweight or obese were generally satisfied with their eating habits (80%). A smaller percent of overweight individuals were satisfied (62%), and only half as many obese individuals were satisfied (34%). As seen in Figure 4.3, there were a variety of reasons why these unsatisfied individuals did not change their eating habits. Over half said that they did not want to give up foods they like and that it takes too much effort to cook healthy meals. Smaller percentages said it was

because they did not understand nutrition guidelines or because healthy foods are too expensive. Another significant difference involves the consumption of fast food. While only 23% of normal or overweight individuals ate fast food once a week or more, half of obese individuals did so (see Table 4.2). Grocery Shopping Characteristics. Individuals were also asked several questions regarding shopping for food (see Table 4.3). Overall, access to food does not seem to be a problem for most individuals. For example, the vast majority of individuals had a grocery store within 15 minutes of their home. Furthermore, almost two-thirds of individuals were very satisfied with the food selection available to them. Finally, 84% said that their income was sufficient to buy the food they wanted. Unfortunately, the other 16% of the sample had to struggle to meet this most basic of needs. Table 4.3. Grocery Shopping Characteristicsa

Percent Commute time to grocery store Less than 15 minutes 15 minutes or more Satisfaction with food selection Very satisfied Somewhat or not too satisfied Income sufficient to buy food you want Yes, sufficient No, not sufficient

90 10

63 37

84 16

Note: a Weighted data, N=201

21

Conclusions and Implications A problem as widespread as obesity needs to be addressed at both the individual and community levels and must take a multi-pronged approach. To begin, interventions aimed at changing individual behaviors must start by increasing people’s awareness of their own weight status. The next step is to educate individuals about the dangers of being overweight and how weight problems can be avoided through better nutrition and exercise. This type of information could be provided in different ways, such as through educational classes offered at community centers, synagogues, libraries, or schools, or through articles included in community newsletters. Issues of motivation could be addressed through the formation of walking clubs or weight loss campaigns sponsored by community groups or leaders. However, these individual changes will be limited if the environment is not changed as well. Communities must ensure that health behaviors and eating choices are possible. To create community areas conducive to exercise, several issues must be addressed, including convenience, safety, and cost. Communities could benefit from safe walking and biking paths, more tennis and basketball courts, and low-cost recreation centers. Better eating habits could be encouraged if community members and leaders address sources of food- from fast food restaurants to farmer’s markets. Restaurants could be pressured to offer more healthy choices and smaller portions, or at least to provide nutritional information about each menu option. Community-level media campaigns could also be used to educate and motivate individuals to lose weight. Because health care providers have been shown to influence patients’ health knowledge and behaviors, encouraging doctors and nurses to be more aggressive in their weight loss advice may be important. The endless number of ways through which obesity could be addressed may seem daunting, but it also gives each community great flexible. Communities can use this flexibility to best use their strengths to deal with weight problems in their neighborhoods. Whether these strengths are a strong local government, particularly influential community groups, or a motivated grassroots campaign, a great deal of research is available to provide evidence-based intervention ideas. Through these efforts, adults and children in West Rogers Park and Peterson Park can be given the necessary tools for achieving (and maintaining) an ideal weight. References: 1. Mokdad AH, JS Marks, DF Stroup, and JL Gerberding. 2004. Actual Causes of Death in the United States, 2000. Journal of the American Medical Association, 291(10): 1238-1245. 2. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, and Marks JS. 2003. Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors, 2001. Journal of the American Medical Association, 289(1); 76-79. 3. Must A, J Spandano, EH Coakley, AT Field, G Colditz, and WH Dietz. 1999. The Disease Burden Associated with Overweight and Obesity. Journal of the American Medical Association, 282(16): 1523-1529. 4. Abid O, Galuska D, Kettel Khan L, Gillespie C, Ford ES, and Serdula MK. 2005. Are Healthcare Professionals Advising Obese Patients to Lose Weight? A Trend Analysis. Medscape General Medicine, Oct. 10, 2005. 5. U.S. Preventive Services Task Force. 2003. Behavioral Counseling in Primary Care to Promote a Healthy Diet: Recommendations and Rationale. American Journal of Preventive Medicine, 24(1): 93-100.

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Selected Topic 5: Overweight and Obese Children

As with adults, obesity was a significant problem among children in the Jewish community of West Rogers Park/Peterson Park. Among children 2-12 years old, 28% were overweight and an additional 26% were obese. In other words, less than half were an appropriate weight for their height. The categorization for children was done according to the CDC’s “BMI-for-age” gender-specific charts.1 Specifically, the following guidelines were used:

• Underweight = BMI for age < 5th percentile • Normal weight = 5th percentile ≤ BMI for age < 85th percentile • Overweight = 85th percentile ≤ BMI for age < 95th percentile • Obese = BMI for age ≥ 95th percentile

In the current report, the prevalence of obesity in this community will be discussed and compared to national data. In addition, demographic, social, and health-related factors that are related to overweight or obese status will be investigated. It is important to note that only 58 interviews were conducted for children and, of these, only 50 were over 2 years of

age (and thus old enough to use the BMI measures). Furthermore, valid height and weight data were only available for 43 of these children. The following discussions are based on this small sample and all of the data is unweighted. Distribution of Weight Status Figure 5.1 shows the percent of children in each BMI category by gender. Boys were more likely to be normal/underweight or overweight, while girls were disproportionately in the obese category. Disturbingly, over one-third of girls in WRP/PP were obese. As a result, there were almost as many obese children as overweight ones. It is also helpful to examine BMI status by age group. As seen in Figure 5.2, older children (those 6-12 years of age) were more likely to be overweight in both the Jewish survey and in a national sample, compared to children 2-5 years of age. This trend is also seen in national data for obesity (see Figure 5.3). In contrast, the younger children in WRP/PP were significantly more likely to be obese. Remarkably, over one-third of children 2-5

Figure 5.1. Children's Weight Status by Gender

0

10

20

30

40

50

60

Normal or Underweight Overweight Obese

Perc

ent Total

MaleFemale


23

Note: Data represents children 2-12 years of age

Figure 5.2. Overweight Status

0

5

10

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20

25

30

35

All children 2-5 years 6-12 years

Perc

ent O

verw

eigh

tWRPNational

Source: Jewish Community Health Survey, 2003 and NHANES, 1999-2000 Note: The national data is for children 2-5 years and 6-11 years of age

years of age were obese in this Jewish community. Together, these three graphs indicate that girls and very young children may be the most important targets for obesity interventions in this community. Perceived Weight Status To better understand factors influencing childhood obesity, the adults responsible for each child were asked about their child’s weight. These questions showed a large discrepancy between the parent’s perceptions and the child’s actual weight status. Overall, nearly half of the parents did not correctly classify their children. This is particularly problematic for those with overweight or obese

children (see Figure 5.4), where less than a quarter of parents of an overweight child correctly perceived that their child had weight problems. These results are almost identical to the findings of another recent study.2

Advice from Doctor If parents cannot adequately identify weight problems in their children, it is increasingly important for physicians to do so. Unfortunately, the data from our survey show that only 24% of overweight or obese children had been advised to lose weight by their doctor in the past year (see Table 5.1).

Figure 5.3. Obesity Status

0

5

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15

20

25

30

35

40

All children 2-5 years 6-12 years

Perc

ent O

bese

WRPNational

Source: Jewish Community Health Survey, 2003 and NHANES, 1999-2000

24

Note: The national data is for children 2-5 years and 6-11 years of age

Eating Habits Numerous questions were also asked regarding typical daily eating habits. Several interesting patterns were seen. For example, overweight children ate more servings of food from most food groups, particularly those groups most strongly linked to weight gain. For example, children with weight problems were more likely to have three or more servings of both dairy products and breads or carbohydrates every day. Unfortunately, approximately two-thirds of all children failed to eat the recommended daily five servings of fruits or vegetables. This number would be even higher if fruit juices were not included in the question. Some differences can be seen among selected “unhealthy” eating habits as well. For example, overweight children were more likely to report eating fast food once a week or more compared to normal children. Because nutrition is important for all children, it is worthwhile to note that one-third of children of all weights reported eating baked goods four or more times a week and approximately one-quarter ate chips at least this often.

Figure 5.4. How Parents of Overweight and Obese Children

Perceive their Child’s Weight

Over-weight

24%About

the right weight

76%


Table 5.1. Weight-Related Issues Among Children a

Normal (%)

Overweightor Obese

(%) Perceived weight status Underweight About the right weight Overweight Advice from doctor Advice to lose weight Eating habits Eats ≥ 5 fruits or vegetables a day Eats proteins > 2 times per day Eats dairy ≥ 3 times per day Eats bread/carbs ≥ 3 times per day Unhealthy eating habits Eats fast food weekly Eats baked goods 4+ times per week Eats chips 4+ times per week Activities Watches TV ≥ 1 hour per day Participates in organized physical activity (includes team sports)

Active play > 1 hour per day

11 78 11

6

32 65 29 65

28 33

28

50 50

53

10 67 24

24

35 24 38 76

38 33

25

52 86

48

Notes: a Unweighted data for children 2-12 years of age

Activities Although several questions were asked about activity levels, few differences were seen among children from different BMI groups. For example, about half of the children in both groups reported watching TV for at least an hour every day, and also being involved in active play for the same amount of time. In addition, some of the differences found were not in the expected direction. Surprisingly, nearly all of the overweight children played in some type of organized activity (such as a sports team), while only half of the normal weight kids did. However, because of the cross-sectional nature of the data, it is hard to discern cause and effect. For example, it is possible that the parents of overweight children (or the children themselves) recognized the weight problem and, thus, were more likely to seek out these activities.

25

Conclusions and Implications Like most communities around the country, West Rogers Park and Peterson Park face a growing problem with childhood obesity. These problems are especially pronounced for girls and those in the youngest age group (2-5 years). Fortunately, research has provided several promising solutions to combat weight problems. These generally involve lowering the amount of fat and calories consumed, while increasing rates of physical activity. The findings from the current study show that there is substantial room for improvement in both of these areas. Specific changes could include educating parents to determine if their child is a healthy weight, encouraging health care providers to discuss weight problems with parents and children, and motivating parents and children to make better food choices to become more physically active. Because of the amount of time children spend at school, schools are an effective location from which to base interventions or to change policies. Increasing the amount of time spent in physical education or recreation, hiring a health educator or nurse to provide health information and weight screenings, updating school lunch or breakfast menus, and increasing the amount of classroom time spent on teaching nutrition are all valuable methods of helping children to maintain a healthy weight. In addition, encouraging teachers to use recess or play time as rewards instead of “treats” would both limit the amount of unhealthy food available to children and increase the amount of exercise. Similarly, establishing policies regarding the types of foods served at class parties is important. Lists of (allowable) nutritional snacks could be provided to teachers and parents or, funds could be collected annually for teachers to provide healthy treats. Finally, offering healthy breakfasts at schools would be another way to systematically increase the availability of healthy foods to children, as well as to set a positive example of healthy eating habits. References: 1. Centers for Disease Control and Prevention (CDC). 2005. Clinical Growth Charts. Retrieved from: http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm. Retrieved on: October 20, 2005.

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2. Jeffery AN, Voss LD, Metcalf BS, Alba S, and Wilkin TJ. 2005. Parents’ Awareness of Overweight in Themselves and Their Children: Cross Sectional Study within a Cohort (EarlyBird 21). British Medical Journal, 330: 23-24.

http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm

Selected Topic 6: Depression

Mental health is as essential to overall health and well-being as physical health. Moreover, mental illnesses, such as depression, are risk factors for many chronic conditions and can have a negative influence on the course and management of these conditions.1 For these reasons, depression is expected to be the second leading source of the global burden of disease by 2020.2 In the current study, three different measures of depression were examined. For the first measure, respondents were asked if they had ever been told by a physician that they were depressed. In contrast to this measure of clinical diagnosis, the second measure used a set of questions to screen for probable depression. These questions, called the Center for Epidemiological Studies Depression (CES-D) scale,3 included a set of ten statements, such as “I felt depressed,” or “I felt everything was an effort.” Individuals with four or more positive responses to these statements were considered likely to be depressed. Finally, individuals were asked if they were depressed in the past month. In WRP/PP, over one-fifth of individuals reported having been diagnosed with depression at some point in their life (see Table 6.1). This is slightly higher than recent national estimates, which find that lifetime depression is reported by 16% of adults.4 In addition, nearly as many adults screened positive for current depression (using the CES-D scale). Although recent national comparisons for this measure are not available, older data shows that this estimate is similar to the general public’s rate of depression. Finally, approximately one-third of adults in this sample reported that they had been depressed in the past month. Again, no good comparison data could be found, but this number is substantially higher than national estimates of depression within the past year.4 In other words, adults in WRP/PP are MUCH more likely to consider themselves as having been depressed compared to other adults in the U.S. Demographic Characteristics Very few demographic characteristics were

Table 6.1. Prevalence of Depression WRP/PP

(%) U.S (%)

Ever diagnosed with depression Screened depressed Depressed in the past month Depressed in past 12 months

21 17 32 --

16 a

19 b-- 7 a

Notes: a Kessler, et al, JAMA 2003 b NHANES, 1975, latest CESD data available at the national level associated with the prevalence of depressive symptoms in this population (using the CES-D scale). For example, prevalence did not vary significantly by age, gender, marital status, fertility, or nativity. This differs from previous studies of depression, which have found that depression is associated with most demographic characteristics.3

In addition, there were no religious differences in the prevalence of depression. More specifically, unaffiliated individuals were no more likely to screen positive for depression than synagogue members. Table 6.2. Socioeconomic Correlates of Depressive Symptoms a

Screened Depressed

(%) Education College degree or more Less than college degree Annual household income Less than $50,000 $50,000 or more Employment status Employed Not employed Insufficient funds for health care Yes No Unmet mental health care needs Yes No

17 19

27 13

14 22

31 13

42 15


27

The percent of depressed individuals also did not vary by denomination or other measures of religious involvement. Socioeconomic Characteristics Some elements of socioeconomic status were also unrelated to the prevalence of depression (see Table 6.2). Specifically, individuals with less education or who were unemployed were statistically no more likely to be depressed than the more educated and employed. This differs from past studies that generally have found that having more education and a job is associated with less depression.4 However, in agreement with prior studies, the prevalence of depression was more than twice as high for individuals who earn less than $50,000 compared to those who earn more. Another financial measure, having an income that is sufficient to pay for health care needs, was also significantly related to depression. Nearly one-third of individuals who reported insufficient funds for health care needs were depressed, compared to only 13% of those with sufficient funds. Finally, 10% of the total sample reported not being able to get mental health care services when they needed them (not shown). Of this group, 42% were currently depressed, as measured by the CESD count of depressive symptoms. Health Status Not surprisingly, depression was significantly associated with poor subjective health (see Table

Table 6.3. Health Correlates of Depressive Symptomsa

Screened Depressed

(%)

ALL Self-rated health Excellent, very good, or good Fair or poor Chronic conditions High blood pressure Diabetes Cancer Heart problems Limitations and disability Limitations in health or social activities Someone in household with a disability

17

11 44

25 42 29 43

29 38

Note: a Weighted data; N=191 6.3). However, it is not known whether depression leads to poor health (or a perception of poor health) or if poor subjective health leads to subsequent mental health problems. Individuals with certain chronic conditions were also more likely to be depressed. Specifically, high percentages of individuals with diabetes and heart problems screened positive for depression. Other findings showed that individuals having any limitations in health or social activities were more likely to be depressed, as were those living in a household where someone has a disability. One striking finding is that overweight and obese

Figure 6.1. Depression and Weight Status in WRP/PP

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50

60

Normal Overweight Obese

Perc

ent Screened

Depressed

DepressedPast Month

28


individuals were significantly more likely to have a high number of depressive symptoms compared to normal or underweight individuals (see Figure 6.1). Specifically, overweight and obese individuals were two to three times more likely to screen positive for depression compared to those who were normal or

underweight. Similarly, overweight and obese individuals were also much more likely to report being depressed in the past month. While 20% of normal weight individuals reported being depressed, over half of obese individuals reported having this problem in the past month.

Conclusions and Implications Because depression affects a substantial proportion of individuals in WRP/PP, and because many people who screened positive for depression have not been diagnosed with it, interventions aimed at detecting and treating this condition are a critical part of the overall effort to improve health and well-being within these communities. The main focus of these interventions is education. In particular, three messages need to be delivered. First, individuals in these communities need to know how to recognize when they (or a loved one) might have a problem. Second, individuals need to be aware that depression can be effectively treated with a variety of methods. Finally, they need to know where to go for help. The Jewish Federation and its agencies need to mount a community marketing effort to educate individuals about available mental health services. These educational and awareness campaigns should also target at least three groups: rabbis and rabbi’s wives, school personnel, and physicians. Individuals in these positions have an opportunity to touch hundreds of individuals if they are more thoroughly trained in detecting, referring, and possibly treating (for physicians) depression. Finally, an overarching issue to address is the stigma that is often attached to mental illnesses. All programs and messages must stress the idea that having a mental illness (such as depression) is similar to having a physical illness (i.e. it is not a sign of “weakness”). Because mental illnesses need to be given the same consideration as physical illnesses, one policy-level change that should be made is increasing the health insurance coverage of mental health services. In addition, the large percent of depressed individuals who reported being unable to access mental health care is also a critical challenge. Although simply knowing where to turn for help is essential, the provision of low-cost or free services is also likely to increase the use of mental health services in these communities. Offering counseling at neighborhood venues, such as community centers or synagogues, may also help to increase both the awareness and accessibility of such services. Special attention to groups who are particularly at risk, such as overweight individuals, is warranted. References: 1. Chapman DP, Perry GS, and Strine TW. 2005. The Vital Link Between Chronic Disease and Depressive Disorders. Preventing Chronic Disease (serial online). January, 2005. Available from: http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm. 2. Murray JL, Lopez AD, editors. 1996. Summary: The Global Burden of Disease. Boston (MA): Harvard School of Public Health. 3. Radloff LS. 1977. The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3): 385-401.

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4. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walkers EE, and Wang PS. 2003. The Epidemiology of Major Depressive Disorders: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289(23): 3095-3105.

Selected Topic 7: Disability

This section will examine the prevalence and consequences of disability. Respondents were not asked directly if they were disabled (due to practical and ethical reasons), but they were asked about the presence of disability within their household. From this question, it was estimated that nearly one-quarter of individuals (23%) in WRP/PP lived with an individual with a disability (see Figure 7.1). This can be compared to 15% of Jewish households in all of Chicago and 29% of American households (using a broader measure of disability). The absolute, and relative, magnitude of disability in WRP/PP warrants further attention. Types of Disability Individuals who responded that they lived with an individual with a disability (note that this could be the respondent as well) were then asked what type of disability the individual had been diagnosed with. Approximately half of this group reported a learning disability (see Figure 7.2). An additional 20% reported a general physical disability. More specific responses were also given. For example, small numbers lived with blind or deaf individuals, individuals with emotional problems, and those with other conditions.

Figure 7.1. Prevalence of Disability in Households

0

5

10

15

20

25

30

35

WRP/PP MCJPS US

Perc

ent

Source: Jewish Community Health Survey, 2003; MCJPS, 2000-2001; U.S. Census, 2000 Special Needs Not unexpectedly, a substantial proportion (45%) of the individuals with a disability had special care needs (see Figure 7.3). These needs were diverse, reflecting the wide range of disabilities discussed above. Many involved either some type of health care provider or a mobility device. In addition, other

Figure 7.2. Types of Disability in WRP/PP

0

5

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30

Physic

al

Learn

ing

Blindn

ess

Autism

Emotion

al

Down S

yndro

me

Deafne

ssOthe

r

Num

ber o

f Cas

es


30

Note: Numbers include multiple mentions

Figure 7.3. Special Needs of Disabled Individuals

0

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Any specialcare

Occupationaltherapist

Speechpathologist

Caregiver Tutoring Physicaltherapist

Other

Num

ber o

f Cas

es

Source: Jewish Community Health Survey, 2003 Note: Numbers include multiple responses service providers, such as tutors and caregivers, were needed by many of the disabled individuals. Characteristics of Adults Living in a Household with Someone with a Disability Certain characteristics were more commonly seen in adults living with someone with a disability compared to those living in households without a disabled individual. For example, the vast majority of adults in households with someone with a disability were under 65 years of age. These adults were also more likely to have children. Perhaps most importantly, individuals living with someone with a

disability were more likely to report certain health problems themselves. For instance, the percentage of individuals who screened positive for depression was nearly twice as high in this group as in the general population. Levels of poor subjective health were also higher for adults in this group. Not surprisingly, individuals living in a household with a disabled individual were more likely to face financial difficulties as well. More specifically, over half of these individuals reported that they had insufficient funds to meet their needs. Likely for this reason, almost half of this group (44%) had used Jewish services in the past year.

Conclusions and Implications A large percentage of families in WRP/PP face unique problems due to disability, especially compared to the general Jewish population of Chicago. Learning disabilities are particularly prevalent. An effort should be made to ensure that each individual with a learning disability gets the special care needed to allow optimal functioning. For example, effective learning strategy interventions are widely known, but may not be available to all who need them. Increasing the availability of these programs, or lowering the cost, may be beneficial. In addition, households containing an individual with a disability were more likely to have special health, social, and financial needs. For example, adults living with a disabled individual had more health problems than other adults. Programs aimed at providing respite for caregivers of disabled individuals would give the caregivers time to take care of their own needs. To deal with the mental health issues, support groups or educational classes may be helpful as well.

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Selected Topic 8: Experiences with Violence The issue of domestic violence has been attracting an increasing amount of attention within the Jewish community. Most recently, Jewish Women International (JWI) initiated a domestic violence needs assessment for the national Jewish population and for the Jewish community of Chicago. 1,2 Specifically, the goal of these studies was to assess the extent of abuse, the needs of abused individuals, and awareness of the problem among Jewish individuals. Data for the assessments was collected through a variety of methods, including surveys, focus groups, and key informant interviews. To facilitate the Chicago study, the Task Force on Domestic Abuse in the Chicago Jewish Community was convened. Together, the national and Chicago studies provided extensive information on domestic abuse from the perspective of survivors, social service providers, rabbis, and other community members. However, due to their design (which did not include representative sampling), these studies do not provide scientifically valid data, but rather offer supporting information for population-based studies like the current one.

Thus, findings from the Jewish Community Health Survey are an important addition to previous work in this area. Specifically, the population estimates provided by this study complement the more qualitative data obtained from the previous needs assessment. Moreover, to our knowledge, this study provides the first prevalence estimates of domestic violence within any Jewish community in Chicago. This section will describe the findings from the WRP/PP study regarding experiences with violence inside and outside of the home for the Jewish community. In addition, associations between violence and other demographic and social characteristics will be presented. Unfortunately, no questions on violence were asked in the MCJPS or the NJPS. However, comparisons with data from other Chicago community areas (as derived from Sinai’s Improving Community Health Survey) are shown below.3

Witnessing Domestic Violence As seen in Figure 8.1, one-quarter of individuals in WRP/PP had witnessed domestic violence. This is very similar to suspected prevalence rates reported in

Figure 8.1. Percent of Chicago Adults Who Have Witnessed Domestic Violence

0

10

20

30

40

50

60

WRP/PP HumboldtPark

West Town SouthLawndale

NorthLawndale

Roseland NorwoodPark

Chicago Community Area

Source: Jewish Community Health Survey, 2003 and Sinai’s Improving Community Health Survey, 2003

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the Needs Assessment on Domestic Abuse in the Chicago Jewish community. Using key informant interviews and surveys of community members and leaders, estimated rates of abuse in Jewish households were thought to be 23-25%.2 While high, this rate is much lower than other Chicago community areas. For example, it is approximately half the rate of both North Lawndale and Roseland. Unfortunately, this type of information is often underreported, so these rates most likely underestimate the actual prevalence of this type of violence (for all populations). The sensitive nature of domestic violence information is highlighted by the fact that less than half of the individuals in the current sample (39%) who witnessed this type of violence actually reported it. This lack of reporting helps to explain why many people are unaware of the extent of the problem. For example, the Task Force’s Needs Assessment found that only 57% of the community members considered domestic abuse to be a “somewhat” or “very” serious issue. Several demographic, socioeconomic, and health variables were associated with the probability of witnessing domestic violence (see Table 8.1). For example, older adults were much less likely to have witnessed this type of violence, as were females. Another significant difference involves marital status. Specifically, divorced or separated individuals were more than three times more likely to have witnessed domestic violence compared to those who are married or single. Although the groups did not differ significantly by the most common measures of socioeconomic status (i.e., education and income), other variables hint at increased risks for those with fewer resources. More specifically, individuals who reported that their income was inadequate (for any need) were significantly more likely to have witnessed domestic violence than other individuals. Victims of Violence Individuals were also asked if they, or members of their household, had ever been a victim of physical, verbal, or sexual violence. Nearly one-third of the sample responded affirmatively. This is lower than estimates from a national survey of women in the U.S.4 This survey found that 44% of women ages 18-64 had (personally) experienced some form of violence in their lifetime.

Table 8.1. Characteristics of Individuals who Have Witnessed Domestic Violence or Who Have a Victim of Violence Present in Their Householda

Has Witnessed Domestic Violence

(%)

Victim of Violence

Present in Household

(%) ALL Age 18-54 years 55 and older Gender Female Male Marital status Married Widowed Divorced/separated Never married Education Less than college degree College degree or higher Annual household income Less than $49,999 $50,000 or more Income sufficiency Sufficientb Insufficient Disabled individual in household Yes No

25

30 13

19 31

23 -- 72 23

18 29

23 25

19 34

26 24

32

40 16

25 41

30 10 79 33

23 38

18 37

30 35

52 27

Notes: a Weighted data; N=201 b Includes health care, food, and religious needs The individuals who had been a victim of violence were then asked about the perpetrator of the violence. In most cases, the perpetrator was a stranger, but there were a significant number of cases in which the perpetrator was a family member or friend. This is different from other research on violence, which finds that intimates (spouse, partner, relatives, or friends) are much more likely to be the perpetrator than strangers.4

33

As seen in Table 8.1, certain characteristics distinguish those who have a victim of violence present in their household. For example, younger adults were over twice as likely to share a household with a victim of violence compared to adults over 55 years of age. Men were also much more likely to have a victim of violence in the house compared to

women. Striking marital status differences also existed. Similar to the domestic violence statistics, those who were divorced or separated had a much greater likelihood of living with a victim of violence. Having children living in the household was also associated with increased risk (not shown). Experience with violence also varied by level of socioeconomic status. Specifically, the percentage of Individuals who lived with a victim of violence was

highest for those with a higher education and greater income. This is contrary to related rates of violence in other populations; for example, rates of intimate partner violence are generally higher for less educated women.5 Having a victim of violence in the household was not related to income sufficiency. Finally, when an individual with a disability was present, over half of the individuals reported violence. This rate is close to double that for households without a disabled individual.

Conclusions and Implications The findings of the current study add to recent efforts to address domestic violence in the Jewish community of Chicago.1,2 Work done by Jewish Women International and other members of the Task Force on Domestic Abuse in the Chicago Jewish Community has greatly improved our understanding of the needs of abused individuals and the organizations who serve them. The recommendations developed by the Task Force provide a valuable blueprint for guiding future work in this area. Some of these recommendations include reinforcing partnerships between groups working on abuse issues, increasing awareness of the problem, increasing funding for relevant programs, and offering educational and awareness programs in both traditional and innovative settings. The current study adds to the work of the Task Force by providing population estimates of domestic abuse and violence within these Jewish communities. While a needs assessment was completed by the Task Force, this information was collected via key informant interviews, surveys of community leaders, and surveys of other groups. The non-representative sampling design and the low response rates (as low as 9.3% for rabbis) preclude drawing broader conclusions from the results. Therefore, the findings of the current study, which are based on a scientifically drawn, representative sample, may be particularly useful in efforts to increase awareness of the prevalence of violence in WRP/PP. Efforts should be made to make this data available to the Task Force and agencies involved with abuse victims for use in educational and awareness programs. It could also be helpful to the Task Force and community agencies as they attempt to gain funding for future projects. References: 1. Jewish Women International. 2004. A Portrait of Domestic Abuse in the Jewish Community: Key Findings of the National and Chicagoland Needs Assessments. 2. Altfeld S. 2004. Domestic Abuse in the Chicago Jewish Community: Needs and Priorities. Report prepared for Jewish Women International. 3. Whitman S, Williams C, and Shah AM. 2004. Sinai Health System’s Improving Community Health Survey: Report 1. Chicago, IL: Sinai Health System. 4. Plichta SB, and M Falik. 2001. Prevalence of Violence and Its Implications for Women’s Health. Women’s Health Issues, 11(3): 244-258.

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5. Straus MA, Gelles RJ, and Steinmetz S. 1980. Behind Closed Doors. Newbury Park, California: Sage Publications.

Selected Topic 9: Genetic Testing Individuals of Jewish descent, particularly Ashkenazi Jews (82% of this sample), have a higher risk for carrying mutations for certain genetic diseases. The American College of Obstetrics and Gynecology recommends that Ashkenazi Jews be offered carrier screening for four specific disorders: Tay-Sachs disease, Canavan disease, cystic fibrosis, and familial dysautonomia. Rates of these disorders can be as much as 20 to 100 times higher in this population.1 To facilitate testing, many Jewish organizations offer genetic screening and counseling. A special program, Dor Yeshorim, offers confidential genetic screening to young adults in the Orthodox community. Designed in the early 1980s by an Orthodox rabbi, the system tests young people before they begin to contemplate marriage. Participants can then use the system to learn their genetic compatibility with potential marital partners. It is particularly important to examine rates of screening within the Jewish population of Chicago because existing data show low rates of testing for at least one “Jewish” genetic disorder. More specifically, in the 1990’s, data from the International Tay-Sachs Disease Quality Control Program indicated that less than 900 people were screened for

Tay-Sachs disease each year in the Chicago area. Not only was this rate substantially lower than in past years, but it was also significantly lower than rates seen for other cities with large Jewish populations. In fact, this screening rate (3 per 1,000 Jewish people per year) was less than half the rates seen for Los Angeles and New York.2 The current data show that, within the Jewish community of WRP/PP, 42% of all adults had been screened for some type of genetic disorders. Because a primary motivation of screening is to prevent birth defects in unborn children, it is particularly important to look at rates of testing among individuals of child-bearing age. As seen in Figure 9.1, rates were highest among those 25-34 years of age, where 83% had been screened. Relatively high rates were also seen for those 35-44 years. Middle-aged and older adults were much less likely to report ever having been screened. For example, only 10% of those over 65 years had been screened in their lifetime. Screening rates also varied by marital status (see Figure 9.2). Of those who were married, 46% had been screened for genetic disorders, compared to 33% of those who were not currently married. The

Figure 9.1. Percent of Individuals Ever Screened for Genetic Disorders by Age Group

0

10

20

30

40

50

60

70

80

90

18-24 25-34 35-44 45-54 55-64 65+Age Group (in years)

Perc

ent

35

Source: Jewish Community Health Survey

Figure 9.2. Ever Screened for Genetic Disorders by Age and Marital Status

0

10

20

30

40

50

60

70

80

All ages 18-44 years 45 years and older

Perc

ent Y

es NotMarried

Married


biggest difference is seen among individuals 18-44 years of age. Other demographic, social, and religious factors were also associated with the likelihood of being tested (see Table 9.1). For example, almost half of individuals with at least a college degree had been screened, compared to approximately one-third of those without a college degree. Likewise, those with higher incomes were also more likely to report having been screened. Those who were employed and those who had children reported higher levels of screening as well. In addition, Orthodox Jews and members of synagogues were more likely to report being screened for genetic disorders, compared to those belonging to other denominations and those who did not belong to a synagogue. Screening Results Of the 42% of individuals who reported having been screened, only a small percentage (13%) found that they were carriers for a genetic disorder. Tay Sachs was the most commonly reported condition; however, the adults reporting this made up less than 5% of the total population. Due to small samples sizes, the prevalence of reported conditions could not be reliably estimated. Motivations and Barriers Individuals were asked several questions to better understand the motivations and barriers to being tested. As seen in Table 9.2, the individuals who had

undergone genetic screening had a variety of reasons for doing so. About half said that they had been tested after being told by their doctor or rabbi about Dor Yeshorim. Approximately one-quarter said that they had been tested due to family concerns. A smaller percentage reported that a family history of genetic disorders prompted their screening.

Table 9.1. Percent of Individuals Screened by Select Characteristics a

Ever Screened

(%) Education College degree or higher Less than college degree Income $50,000 or more Less than $50,000 Employment status Employed Not employed Children Any children No children Synagogue member Yes No Orthodox Yes No

47 34

49 30

46 37

56 28

46 26

53 22

36

Note: a Weighted data; N=85

Individuals who had not been screened also received further questioning to assess perceived barriers. The majority of the responses fell into three main groups. First, nearly half of the sample reported that they knew of the tests, but did not feel like it was necessary to be tested. Note that this group includes many adults, primarily young ones, who were not married (and, thus, may not “need” the tests yet for childbearing purposes). An additional one-quarter of the sample (approximately) said that they never considered testing. Similar to this is the final group who said that they did not even know such tests existed, or where one would go to take them. A variety of more specific reasons were provided by the remainder of the respondents. Finally, individuals were asked if they had heard of the Center for Jewish Genetic Disorders. This Chicago agency was created by the Jewish United Fund/Jewish Federation of Metropolitan Chicago and Children's Memorial Hospital in 1999 to increase

Table 9.2. Motivations and Barriers to Genetic Screening in WRP/PP

Percent Reasons for Being Screeneda

Told by doctor or rabbi about Dor Yeshorim To ensure a healthy family, a good idea before marriage or pregnancy Family history Other reasons Reasons for Not Being Screenedb

Considered testing, but felt no need Never considered testing Did not know such tests existed or where to get them Other reasons

48

24

15 12

44 28 11

17

Notes: a N=85; b N=116 knowledge and awareness of Jewish genetic disorders. In the current sample, less than half (42%) of adults reported that they had heard of this center.

Conclusions and Implications Screening for genetic disorders is important for Jews who are planning to have children. More specifically, the Chicago Center for Jewish Genetic Disorders (CCJGD) targets adults 25-40 years of age, because they are considered to be from one to five years away from having children. However, in the current sample, many adults in this age group had never been screened, including nearly 30% of those who were already married. To address this problem, it is critical to understand both the motivations that resulted in screening for some and the barriers reported by others. For example, approximately half of those who had been screened reported that their main reason for doing so was a recommendation from a doctor or rabbi. This suggests that interventions aimed at educating and encouraging these individuals to provide information and referrals may be an effective means of increasing screening rates. On the other hand, additional efforts to raise community awareness may also be valuable because many reasons given for not being screened involved a lack of knowledge about the tests and their importance. Educational campaigns offered through synagogues, women’s organizations, community centers, campus Hillels, and mass media should all be expanded. For example, in Chicago, it is critical that the CCJGD continue its efforts toward educating college students about the importance of screening. Continuing and expanding partnerships with other groups who do on-campus education and outreach is an important aspect of this work. In addition, new outreach methods should be explored, such as the use of peer-to-peer education. Finally, while not frequently reported as a barrier here, cost is often a major impediment to screening. Programs that offer free or reduced cost screenings are crucial for increasing rates. Through these means, we can help to ensure healthier families in the future. References: 1. Chicago Center for Jewish Genetic Disorders website. About Jewish Genetic Disorders. Retrieved from: http://www.jewishgeneticscenter.org/what/. Retrieved on: October 4, 2005.

37

2. Jewish United Fund website. JUF/JF Directory of Services: Chicago Center for Jewish Genetic Disorders. Retrieved from: http://www.juf.org/services_resources/directory.asp?id=0035. Retrieved on: September 7, 2005.

http://www.juf.org/services_resources/directory.asp?id=0035

Selected Populations

The previous sections of this report focused on specific health outcomes or behaviors. In contrast, the following sections will focus on three selected groups of individuals who may have special health-related needs and vulnerabilities. For each of these

groups – families, older adults, and those living in low-income households – a general profile will be given, with special emphasis on health problems and health-related challenges.

Selected Population 1: Families Certain types of families may experience greater demands and, therefore, be more at risk for financial and health-related problems. Two types of potentially vulnerable families will be discussed here – large families and families headed by a single parent. Exactly half of the individuals in the Jewish Community Health Survey lived in a household with at least one child (see Figure 1). The first part of this section will compare adults who did not have children (50%) to those with small (one to three children) and big (four or more children) families (35% and 15%, respectively). As seen in Figure 1, these big families are much more common in WRP/PP than in the overall Jewish population of Chicago. Demographics The average adult with children in the household was 40 years of age, which was significantly younger than

those without children (approximately 59 years). As could be expected when looking at a group of individuals living with children (and who are generally younger), a much greater percentage of this group was currently married. For example, only 59% of those without children were married, compared to 84% of those with 1-3 children and 92% of those with four or more. Socioeconomic Status Socioeconomic resources varied widely between family types. Individuals without children were significantly less likely to have a college education. Specifically, while half of those in childless homes had a college degree, over 80% of those with 1-3 kids and 60% of those with 4 or more kids had attained this level of education. Similarly, levels of household income for those with children were also elevated relative to the rest of the sample (see Figure

Figure 1. Number of Children in Household

0

10

20

30

40

50

60

70

80

0 1 2 3 4 5 6+

Number of Children

Perc

ent WRP/PP

MCJPS

38

Source: Jewish Community Health Survey, 2003 and MCJPS, 2000-2001

Figure 2. Income Distribution by Number of Children

05

101520253035404550

< $49,999 $50,000-69,999 $70,000-99,999 >$100,000

Perc

ent No kids

1-3 kids4+ kids


2). For example, the percentage of parents earning over $100,000 per year was approximately four times as high as for adults without children in the household. Looking at it another way, although nearly two-thirds of childless homes had an annual income of less than $70,000, only one-third of families with 1-3 kids and only 16% of the 4 or more children families were in this bracket. The high levels of income seen for most families in WRP/PP were not seen in the MCJPS. For example, in the MCJPS, nearly 50% of families with 1-3 children and approximately 60% of families with 4 of more children had incomes less than $75,000 (not shown). Health Status Differences in health-related outcomes between family types were also found; however, the majority simply reflected age differences between the groups.

One interesting finding shows that the percent of adults living in households where someone is disabled was significantly higher for those with children (38% for those with 4+ kids, 27% for those with 1-3 kids, and 16% for those without children in household). While this can be explained by larger family sizes (and, thus, a greater chance of living with someone with a disability), it is still important to be aware of extra challenges facing these households. Religious Characteristics Not surprisingly, adults living in households with children appear to be more religiously involved (see Table 1). For example, they were significantly more likely to belong to a synagogue. This linear pattern was also seen in the MCJPS. In this city-wide sample, 39% of adults with no children in the household belonged to a synagogue, compared to

Table 1. Religious Characteristics of Adults With and Without Children in the Household a

No Children

(%)

1-3 Children

(%)

4 or More Children

(%) Religious characteristics Member of synagogue Orthodox Kosher home Jewish spouse Received services from a Jewish organization

73 76 70 97

13

87 78 81 92

39

94 94

100 100

40

39


49% of those with 1-3 children and 57% of those with 4 or more children. The largest families were particularly distinct in all aspects of religious commitment. For example, one-hundred percent of these families were Orthodox, kept a Kosher home, and had a Jewish spouse (if married). Another interesting difference is that the percent of individuals who had received services from a Jewish organization was significantly higher for those with children in the household. It should be noted that controlling for age differences reduced the magnitude of many of these religious differences; however, most remained at least moderately significant. Single Parent Families Approximately 15% of the households with children were headed by a single parent. (Due to the small number of adults in this group, all information given here should be interpreted with caution and emphasis should be placed on trends in the data instead of actual estimates.) Demographically, the majority of single parents never married. Most of the remainder were divorced or separated, while only a small percentage were widowed. Single parent families were at greater risk for both financial and health problems. Most strikingly, almost half of these families had incomes that fell below the federal poverty line (see Table 2). Single parent families living in WRP/PP were significantly worse off than those in the MCJPS. For example, in the MCJPS data, only 17% of single parent households earned less than $25,000 a year. (This would only qualify as being below the poverty line for families with ≥ 6 members.) Thus, even using

Table 2. Challenges Facing Single Parents Single

Parents (%)

Total Sample

(%) Financial problems Below poverty line Health problems Household member is disabled Screened depressed Depressed in past month Unmet health care needs

45

52 24 38 38

10

23 17 32 23

Note: Small sample size for single parents; use caution this generous measure of need, nearly three times as many single parent families in WRP/PP were considered poor Health problems were another area of concern. For example, over half of single parents had an individual with a disability in their household. This is substantially higher than estimates for the sample as a whole. Perhaps because of the increased financial problems and likelihood of living with an individual with a disability, single parents were more likely to screen positive for elevated depressive symptoms and to report being depressed in the past month. Finally, a large percentage of single parents had gone without needed health care. It is also important to note that, in addition to the financial and health problems highlighted above, single parents may also challenged by a lack of social support. For example, a potentially significant source of support – membership in a synagogue - was missing for many of these families. Specifically, only 59% reported belonging to a synagogue, compared to the sample estimate of 81%.

40

Conclusions and Implications Many different types of families live in these communities. While most of the large families appear to be relatively well-off, families headed by single parents face significant challenges. Most notably, almost half of these families were living in poverty. A special effort must be made to reach these individuals. In particular, efforts to encourage these families to belong to a synagogue and to connect with Jewish Federation agencies where they could access needed services and funds may be especially important. While the numbers are small, the disproportionately high percentage of single parent families that include an individual with a disability should also be addressed. Single parents have fewer resources in many areas (financial, social, parental, etc.) and those dealing with the challenges of disabilities need even more support. Finally, the higher levels of depression reported (but not diagnosed) for this group is troubling. Educational services may be needed to help these individuals recognize their own mental health issues and to know where to go for help. Babysitting and respite services may also be needed to allow single parents time to get the help they need. A final consideration is that the number of divorced individuals is growing across the country, even within the Jewish community. For example, the percentage of divorced or separated Jewish adults nationwide ranges from 10-23%, depending on the survey. This trend will lead to an even greater number of single parents in the future. Care must be taken to create a support system within the Jewish community for these vulnerable families. Support groups meeting at synagogues or community centers would be one way to provide emotional assistance to these parents. Failing to acknowledge the problem, or to accept single parents, will only increase the burden on individuals and the community.

41

Selected Population 2: Older Adults Older adults often face special challenges, particularly those related to deteriorating health and dwindling financial resources. In WRP/PP, 20% of adults were 65 years of age or older. Within this age group, individuals were almost evenly split between the “young old” (65-74 years), “old old” (75-84 years), and the “oldest old” (85 years and older). The percent of the population that is over 65 years is similar to that found in the MCJPS; however, WRP/PP has a larger proportion in the older categories. More specifically, only 3% of adults in the MCJPS were over 80 years of age. Due to the small sample size of the current data, only differences between older adults (65 years and older) and younger adults (18-64 years) will be discussed here. Demographics The demographic characteristics of older adults indicate that nearly two-thirds of those in this age group were female (see Table 1). Older adults were less likely to be married and more likely to be widowed, compared to the rest of the sample. In addition, all of the older adults in the current study had been married, in contrast to 19% of the younger adults who had never married. Finally, a greater proportion of older adults were immigrants compared to those less than 65 years of age. Specifically, nearly one-third of older adults were foreign-born.

Table 1. Comparisons of Demographic Characteristics Between Age Groups ab

Older Adults c

(%)

Other Adults

(%) Gender Female Male Marital status Married Widowed Divorced/separated Never married Nativity US born Foreign born

61 39

64 30 7 0

70 30

50 50

75 1 6

17

83 18

Notes: a Weighted data; N=201 b Percentages may not add to 100 due to rounding c “Older Adults” refers to those ≥ 65 years, “Other Adults” to those 18-64 years Religion and Jewish Involvement Significant age differences can be seen when examining the religious composition of the sample, as seen in Figure 1. To begin, older adults were much less likely to report belonging to an Orthodox synagogue. In contrast, they were much more likely than younger adults to belong to a Traditional or

Figure 1. Religious Affiliation by Age Group

0

10

20

30

40

50

60

70

80

Orthodox Traditional Conservative Reform None

Perc

ent Older

Adults

YoungerAdults


42

Table 2. Religious Involvement of Older and Younger Adultsa

Older Adultsb

(%)

Other Adults

(%) Member of synagogue Keeps a Kosher home Jewish spouse Received Jewish services in past year Insufficient funds for religious obligations

66 53 98 7

10

85 85 95 33 27

Notes: a Weighted data; N=201; b “Older” refers to those ≥ 65 years, “Other” to those 18-64 years

Conservative synagogue. Very few Reform Jews were seen, for either age group. Finally, older adults were significantly more likely to report not belonging to a synagogue. Lower levels of synagogue membership for older adults were not seen in the MCJPS. There, 45% of older adults belonged to a synagogue, compared to 41% of younger adults. Other aspects of religious involvement are shown in Table 2. Here, one can see that older adults were significantly less likely to keep a Kosher home. They were also less than one-quarter as likely to report receiving services from a Jewishly funded organization in the past year. Finally, older adults were significantly more likely to have an income that was sufficient to meet their religious obligations.

This was also found in the MCJPS, where a much larger percentage of younger adults reported insufficient funds, compared to older adults. The cost of religious education is presumably the main source of these differences. Economic Resources Although simply observing differences between age groups for different demographic and social factors is interesting on its own, it is also important to focus on older adults because they may lack certain resources that are more plentiful in younger populations. For example, older adults were significantly more likely to have low levels of education (high school or less) and were less likely to have a graduate degree compared to younger adults (see Table 3).

Table 3. Comparisons of Social and Economic Characteristics By Age Group ab

WRP/PP MCJPS c U.S. d Older

Adults (%)

Other Adults

(%)

Older Adults

(%)

Other Adults

(%)

Older Adults

(%)

Other Adults

(%) Education High school or less Some college College degree Graduate degree Household income Less than $30,000 $30,000-$49,999 $50,000-$69,999 More than $70,000 Social support Lives alone

28 30 30 12

25 39 25 10

27

6

24 40 30

12 12 20 57

5

21 30 31 18

24 27 22 28

44

7

18 44 32

11 20 23 46

23

65 18 11 7

53 28 9

10

31

45 29 18 8

22 28 21 29

11

Notes: a “Older Adults” = ≥ 65 years, “Other Adults” = 18-64 years; Percentages may not add to 100 due to rounding b Jewish Community Health Survey; weighted data c MCJPS, 2000-2001; Income categories differ (< $25,000, $25,000-$49,999, $50,000-$74,999, $75,000+) d U.S. Census Bureau, 2003

43

Figure 2. Self-Rated Health by Age Group

05

1015202530354045

Excellent Very Good Good Fair Poor

Perc

ent

OlderAdultsOtherAdults

Source: Jewish Community Health Survey, 2003 Older adults were also less likely to be currently working (not shown). Primarily due to these reasons, older adults had lower household incomes. For example, older adults were much more likely to be in the lowest income category and much less likely to earn more than $75,000. Note that older adults in the two Jewish populations have substantially greater resources, in terms of education and income, compared to older adults in the U.S. It is also important to note that older adults tend to live in households with fewer people. For this reason, their per capita income was similar to that of younger adults. More importantly, older adults in WRP/PP were not more likely to be living in poverty. In addition, older adults did not report having insufficient funds for specific needs (such as health care or food) more than younger adults. Again, this was similar to findings from the MCJPS. For example, in the Chicago sample, 27% of younger adults reported that they were “just managing” or that they could not “make ends meet.” This indicator of limited financial resources was significantly lower in older adults, where only 20% reported such difficulties. Social Resources Older adults may differ in the amount of social resources available to them as well. One primary source of social support is fellow household members. Unfortunately, the percent of older adults living alone in WRP/PP (27%) was more than five times as high as younger adults (see Table 3).

However, this percentage is still lower than that seen in other populations, especially the MCJPS (44%). Health Status Perhaps the largest difference between older and younger adults involves health status. As seen in other populations, older adults in WRP/PP face many more health problems than younger adults. Table 4. Comparisons of Health Characteristics Between Older Adults and Other Adultsab

Older Adults

(%)

Other Adults

(%) Chronic conditions High blood pressure Diabetes Cancer Heart problems Arthritis Asthma Other limitations Limited in past month Depression Screened depressed Health behaviors Current smoker Former smoker Drinks alcohol Moderate activity Vigorous activity

63 13 20 35 65 5

37

27

0

42 39 45 18

25 5 3 7

15 11

27

15

5

26 55 51 29

Notes: a Weighted data; N=201;

44

b “Older” = 65+ years, “Other” = 18-64 years

Table 5. Differences in Utilization and Access to Health Carea

Older Adults

(%)

Other Adults

(%) Preventive health care utilization Blood pressure test (in past year) Mammogram (in past year, females, ≥50 yrs) Breast self-exam (females) Pap smear (in past year, females) PSA (ever, males) Colonoscopy or sigmoidoscopy (ever, ≥50 yrs) Blood stool test (ever, ≥50 yrs) Access to care Health insurance Private health insurance Ever pay cash for health care Did not get care when needed b

Income insufficient for health needs

96 82 53 32 72 61 88

98 50 39 16 20

90 55 55 76 31 54 67

95 90 37 26 29

Notes: a Weighted data; 2003; “Older” = 65+ years, “Other” = 18-64 years b Includes medical care, dental care, prescription medications, mental health care, and eye care

Consequently, older adults were more likely to rate their health as “Good,” “Fair,” or “Poor,” and less likely to rate their health as “Excellent” or “Very good,” (see Figure 2). Another important indicator of health status is the presence of chronic conditions. As seen in Table 4, older adults were significantly more likely to suffer from high blood pressure, diabetes, cancer, heart problems, and arthritis. In fact, adults over 65 years of age were two to six times as likely to report these conditions. The most striking disparities involve diseases such as cancer and heart disease. Older adults were also more likely to report having activity limitations due to physical or mental health problems in the past month. Perhaps at least partially due to these health problems, older adults were almost twice as likely to screen positive for current depression. In terms of health behaviors, older adults were less likely to smoke, drink, or report regular physical activity. Utilization and Access to Health Care Finally, older and younger adults appear to utilize

health care services differently. For example, older adults were more likely to report the use of several preventive services, including blood pressure screening, mammograms, PSA tests, and blood stool tests (see Table 5). In contrast, older women were significantly less likely to report having a Pap smear the past three years. No age differences were seen for services such as breast self-exams. Similar to levels of utilization, levels of access also varied by age group. One significant difference is that older adults were much less likely to have private insurance. However, very high levels of insurance were seen for both age groups. Specifically, 98% of adults over 65 years of age and 95% of younger adults had some type of insurance. Older adults were equally as likely to pay cash for services when uninsured, but were slightly less likely to forgo needed health care. They were also slightly less likely to report that their income is insufficient to meet their health care needs.

45

Conclusions and Implications Like most societies throughout the developed world, the Jewish communities in WRP/PP and in Chicago are aging. While approximately one-fifth of adults in both communities are over 65 years of age, this percentage is expectedly to significantly increase in the coming years. Thus, these communities need to begin preparing now for the increased health and social service needs that will soon confront them. Although many of the special challenges facing this group are highlighted here, positive findings were seen as well. For example, older adults in WRP/PP were not particularly disadvantaged socioeconomically. Although they generally reported lower incomes, they were no more likely to live under the poverty line or in low-income households than younger adults. They also were not more likely to have insufficient funds for basic needs like health care, food, and religious obligations. However, as expected, they had more health problems than younger generations. For example, a large number of older adults were struggling with chronic conditions. This highlights the need for disease management services and information. Another area of concern is their mental health status. Older adults were more likely to screen positive for depression. Programs aimed at detecting these conditions in older adults may be beneficial, as may programs designed to increase the accessibility of mental health services. One example of an effective mental health program is the Partners in Care project developed by the Council for Jewish Elderly (CJE). In this project, a service model for identifying and treating depression among the elderly was implemented and evaluated. The Partners in Care project found that incorporating social workers into primary care teams improves the physical and mental health outcomes of older patients, as well as increases health care providers’ awareness of mental health issues in aging. Future interventions building on the knowledge gained from this project, and others, will be important in improving the overall well-being of older adults in these communities. For all interventions, consideration must be given the special circumstances of older adults, such as their greater likelihood of having physical limitations, living alone, and not belonging to social organizations such as synagogues. These circumstances also indicate that many older adults may be in need of additional sources of social support. Many services are already offered by CJE, Jewish Child and Family Services, and other organizations; however, it is likely that many seniors are not aware of the existence or variety of these services (e.g., subsidized housing and congregant meal programs). More education and advertising about these types of programs may increase the number of older adults who use them to increase their involvement in the community and to maintain their independence. One example of a recent project designed to address these issues is the Naturally Occurring Retirement Community (NORC) project. NORC is a model developed by CJE and the Jewish Federation to improve the ability of older adults to continue living independently in the community by increasing their access to supportive services. This two-year demonstration project has been shown to be an effective way to increase levels of community involvement, knowledge of services, and access to these services among the older adults living in the participating buildings. Finally, older adults may also be unaware of efforts undertaken by synagogues to increase the accessibility of their services and to offer special programs for their age group. In particular, subsidized memberships may be important in attracting (and keeping) more senior members involved in synagogues.

46

Selected Population 3: Low Income Households Compared to the general population, the Jewish community in Chicago (and elsewhere) is relatively affluent. For example, Jews in Chicago and WRP/PP are much more likely to report higher incomes (see Table 1, page 7). However, certain segments of this population continue to struggle with financial difficulties. For example, in the MCJPS, 25% of the sample reported that they “Can’t make ends meet” or are “Just managing.” Similar levels of financial difficulties were seen in WRP/PP. To facilitate the discussion about levels of financial resources in the current study, individuals were placed in one of three distinct groups. The first group includes all individuals who have incomes that qualify them as living below the poverty line. This was determined using the Federal Poverty Thresholds for 2003, which indicate that, for example, a household with five individuals would need to earn more than $22,245 to be above the poverty line. Although the income categories used in the current survey did not allow for an exact determination of poverty status, they provide a good approximation of which households face this level of financial disadvantage. The second group is comprised of individuals living

in low-income households. These individuals reported having a per capita household income that is roughly 100-150% of the federal poverty threshold limits. This group may not qualify for assistance in many federal and state programs, but individuals in low-income households are at risk for many of the problems associated with poverty. For a family of five, household incomes of less than $30,000 would qualify as low-income. The final category represents all individuals with household incomes above this level. The current section of the report will compare the demographic, social, and health-related characteristics of these three groups. When reviewing the findings discussed below, please be aware of the small sample sizes for the low-income and poverty groups. At the end of the section, special attention will be paid to individuals who reported having insufficient funds for certain needs. As seen in Figure 1, 10% of adults in this community were found to live beneath the poverty line. In total, nearly twenty percent of adults lived in low-income or poor households. The percentage of individuals living under the poverty line and in low-income households was higher for specific subgroups. In

Figure 1. Percent of Individuals Living Below the Poverty Line or in a Low-Income Household

0%

10%

20%

30%

40%

50%

60%

All Elderly Single Parents Immigrants Large Family

LowIncome

UnderPovertyLine


47

Note: Large family indicates adults with 3 or more children in the household

Table 1. Health and Social Service Needs Associated with Households Below the Low-Income Threshold and Poverty Line a Below

Poverty Line (%)

Low- Income

(%)

All Other (%)

Went without needed health care services No health insurance Fair or poor self-rated health Insufficient funds to pay for child’s school Did not receive Jewish services in past year

30 14 30 75 82

42 -- b

-- 58 72

20 3

20 44 71

Notes: a Weighted data; N=201 b Cell size less than 5

particular, single parents were much more likely to be living under the poverty line, compared to all other adults. As noted in the section on families, significantly more single parents in WRP/PP have low incomes compared to those in the larger Jewish community of Chicago. Interestingly, older adults, immigrants, and adults with large families were statistically no more likely to live in low-income households than younger adults. While the previous section noted the lower household incomes for older adults, the per capita measure eliminated these disparities. Individuals with lower incomes can be expected to have less access to health care services and a greater need for social services. For example, of those in the low-income group, over 40% had gone without some type of needed health care service (see Table 1). In comparison, only 20% of individuals above the

threshold reported such difficulties. Similarly, the percentage of individuals lacking health insurance was two to three times as high for those in households below the poverty line compared to those not in an at-risk income category. This may be especially problematic because individuals with low incomes were more likely to rate their current health as fair or poor. It is interesting to note, however, that other health measures that would be expected to vary by poverty status did not. For example, individuals living below the poverty line were no more likely to have problems with depression than individuals with greater per capita incomes (not shown). Meeting educational needs was also a problem for many respondents. Over half of those in low-income households and three-fourths of those living below the poverty threshold reported that they did not have enough money to pay for their child’s education.

Table 2. Demographic and Social Characteristics of Jews Living in Low-Income and Poverty Households a

Below Poverty Line

(%)

Low-Income

(%)

All Other (%)

Family structure Married Never married Single parent Religious involvement Synagogue member Jewish spouse Education Less than college degree Employment status Currently employed

43 45 30

77

100

57

59

69 25 -- b

78

100

44

44

77 8 4

82 95

32

61

Notes: a Weighted data; N=201

48

b Cell size less than 5

Figure 2. Insufficient Funds for Various Needs

05

101520253035404550

Any Health Care Food Religion Education *

Type of Need

Perc

ent

Source: Jewish Community Health Survey, 2003 Note: Education data is for adults with children in the household (n=84) Despite these needs, those living in households below the poverty threshold were less likely to receive Jewish services in the past year. In fact, 82% of this group did not receive services from a Jewish organization. More information about individuals living in poor households can be seen in Table 2. Marital status differs widely between those below and above the income thresholds. More specifically, significantly fewer individuals living below the poverty line were married compared to those living in low-income households. And, both of these groups were less likely to be married than those living above the low-income line. In addition, a large percentage of individuals living in below poverty and low-income households had never been married. Likewise, fewer of the poorer adults were currently married. A related disparity is that 30% of those living in poverty were single parents, compared to only 4% of the rest of the sample. Approximately the same percent of individuals living in low-income households belonged to a synagogue compared to those with higher incomes. Also, there were no differences by type of affiliation or rates of intermarriage. Finally, as could be expected, levels of education and employment differed between the two groups. Those living in poverty were less likely to have attained a high school, college, or graduate degree. Likewise, those in low-income households were less likely to be currently employed.

Insufficient Funds To better understand what types of financial hardships exist, individuals were asked if their income was sufficient to meet certain needs, such as health care needs, desired foods, religious obligations, and their child’s education. The percent of individuals who were unable to meet each of these needs is shown in Figure 2. Specifically, over one-quarter (28%) said that their income was not sufficient to meet their current health needs. Furthermore, approximately 15% of adults said that their income was not sufficient to buy desired foods. Nearly one-quarter reported having insufficient funds for religious obligations and a much larger percent (46%) said that their income was not sufficient to pay for their child’s education. Overall, 45% reported insufficient funds for one or more of these needs. (Note that education needs were only asked of parents, thus, the total percentage is lower than that for education alone.)

Separate analyses (not shown) indicated that certain demographic traits were associated with having insufficient funds. For example, younger adults were almost twice as likely to have insufficient funds, compared to those over 65 years of age. As discussed in the previous section, this was also found in the MCJPS. Women were also more likely than men to report such problems. In regards to family structure, the likelihood of having insufficient funds did not differ by marital status, but was significantly higher for those with children.

49

Not surprisingly, having insufficient funds was also related to various measures of socioeconomic status (Table 3). Although not statistically significant, trends in the data showed that higher levels of education were associated with a lower likelihood of having insufficient funds. Higher levels of income were significantly associated with insufficient funds, also in the direction that one would expect. Interestingly, employed individuals were more likely to report not having enough money for certain needs than the unemployed, but this may be at least partially due to the greater net worth of older, retired adults. Individuals without health insurance were more likely to report insufficient funds. As could be expected, individuals who used Jewish services in the past year were also more likely to report having insufficient funds for health, food, religion, or education. However, only 40% of those with insufficient funds (36 of 89 individuals) reported using Jewish services in the past 12 months. Thus, the majority of individuals who could not afford things vital to their well-being still did not appear to be using the services available to them through the Jewish community. Of course, individuals could be using Jewish services, but not reporting them (because they forgot, or did not realize certain services or funds were provided by a Jewish agency, for example). Finally, there were no differences in the likelihood of having an insufficient income for certain needs between synagogue members and non-members, or between Orthodox Jews and members of other affiliations. Comparison with MCJPS The number of individuals struggling with unmet needs in WRP/PP can be compared to similar findings from the MCJPS. In the MCJPS, respondents were asked whether they (or any member of their household) needed help that could have been provided through a social service, health, or

Table 3. Insufficient Funds by Level of Socioeconomic Resources a

Notes: a Weighted data; N=201

b For any needs (includes health care, food, religious obligations, and children’s education educational agency. Respondents were given seven different types of needs, such as financial assistance, services for mental disabilities, and services for the elderly. Overall, 26% of the sample reported at least one problem. The top three needs were for personal or family problems, job assistance or career counseling, and financial assistance. In addition, the MCJPS asked respondents if cost prevented them from certain activities, such as belonging to a temple, keeping Kosher, or sending their child to Jewish day school. Interestingly, the percentage reporting that cost precluded sending their child to day school was 11%. This low number may be better understood when it is known that an additional 20% of adults reported that their children received a scholarship or tuition reduction for a Jewish education.

Percent with Insufficient

Funds b

Education Some college or less College degree Graduate degree Annual household income

Less than $50,000 $50,000-$99,999 More than $100,000 Employment status Employed Not employed Health insurance Insured Not insured Use of Jewish services in past year Yes, received services No, did not receive services

52 44 37

56 49 30

50 36

43 83

65

50

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Conclusions and Implications Nearly one-fifth of the adults in WRP/PP were found to live in low-income or below the poverty line households. This confirmed results from the MCJPS that showed that the north side of the city was home to the highest percent of low-income Jewish individuals in the Chicago metropolitan area. The problems associated with low income, such as unmet health care needs and poor health, are also extensive, particularly among members of certain subgroups, such as single parents. Overall, nearly half of the sample reported having an income that was insufficient to meet critical needs involving health care, food, religious obligations, and education. Now that the widespread nature of these financial needs within the WRP/PP community is known, steps need to be taken to address them. To begin, Jewish agencies serving the community must confront the most basic of needs – food. If sufficient food distribution services (such as Meals-on-Wheels, soup kitchens, and community pantries) exist, an effort must be made to make these more well-known, accessible, and free from stigmatization. In addition, providing needy families with “credit cards” to use for food purchases that are indistinguishable from other cards may be worthwhile. Educating rabbis, teachers, and other members of the community who may be in a position to recognize this type of need about these services is also important. Services, such as those provided by Jewish Child and Family Services, Sinai Health Systems, and Council for Jewish Elderly, are especially important in helping individuals to access appropriate state and federal funds and services. Funding these agencies to allow them to employ sufficient social workers to meet the demands for their services is particularly imperative, given the number of low-income families observed in this study. The Jewish Federation is currently involved in an effort to develop a community plan to address these issues. Finally, continuing to offer subsidized memberships to synagogues may be an important way to reach the nearly 25% of the sample who reported having problems meeting their religious obligations. Because these individuals are likely to have other needs as well, it is important to keep them involved in the community, where these needs can be most effectively addressed.

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Future Directions The purpose of this survey was to determine the prevalence of various physical and mental health problems among individuals living in WRP/PP, as well as to uncover issues related to access to care. Having accurate health data is important for communities because it serves to both identify problems and to motivate individuals to address those problems through the creation of health interventions. As seen in the previous sections, individuals living in WRP/PP are facing numerous health-related challenges. Fortunately, these findings have already inspired concerned community members and agencies to develop projects that will improve overall levels of health and well-being. Some of these projects are described below. Although many health issues were uncovered by the survey, the widespread nature and the serious repercussions of childhood obesity prompted the WRP/PP community to concentrate their initial efforts on this issue. Specifically, an initiative has been developed by the Jewish Federation and the Sinai Heath System to develop and implement a school-based nutrition and physical activity demonstration project for the Jewish Day School system (the Associated Talmud Torahs). Briefly, the intervention will require the pilot schools to undertake three important preliminary tasks. These tasks are (1) to form a school wellness committee, (2) to conduct an assessment of the school’s health-related strengths and weaknesses, and (3) to write a school wellness policy. The school wellness policy, and the remainder of the intervention activities, will focus on the following five areas: health education, physical education, family involvement, school environment, and staff wellness. Specific projects and curriculum changes will be undertaken in each of these areas, under the guidance of a public health professional and a registered dietician. The project will be pilot tested in two schools and then implemented more widely

within the remaining schools of the Day School system after two years. Generous funding to support this pilot project has been awarded to the Jewish Federation and the Sinai Urban Health Institute from the Polk Bros. Foundation, Michael Reese Health Trust, and Washington Square Health Foundation. Projects designed to address obesity through other channels are also underway. For example, a health promotion intervention is currently being designed for the early childhood programs, in cooperation with Jewish Child and Family Services. This program will provide education for parents on a variety of topics related to nutrition and physical activity for families. In addition, a coalition is being formed to create plans for a community-wide obesity prevention initiative. This initiative will involve rabbis and other community leaders in an attempt to make changes at the community-level. Data from this survey has also motivated individuals and agencies to confront other health problems identified by the survey. For example, the Council for Jewish Elderly is currently considering possible interventions to address a host of health issues relevant to aging adults. Individuals and agencies have also expressed interest in a community-wide initiative to deal with the mental health issues highlighted in this report. Specifically, efforts to increase the detection and treatment of depression may be forthcoming. These interventions illustrate the tangible benefits of collecting local level health data. Specifically, the findings have increased the likelihood of community-based initiatives being both developed and funded. Through these means, research will be translated into real health gains for Jewish individuals living in West Rogers Park and Peterson Park.

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Concluding Remarks This report summarizes findings from the groundbreaking Jewish Community Healthy Survey. This study provides extensive information about the health of individuals living in two Jewish neighborhoods in Chicago. This information is critical because it offers these neighborhoods a unique opportunity to improve individual levels of health and well-being. The Jewish Community Health Survey also increases our knowledge about the demographic characteristics, socioeconomic status, and levels of religious participation of individuals in this community. In addition, this report contains data from other sources so that the current findings can be put into context, as well as compared to other Jewish populations, the city of Chicago, and the U.S. In general, the findings indicate that the individuals in these neighborhoods were as healthy (or healthier) than the average residents of Chicago or the U.S.; however, many serious health concerns still exist for both adults and children. For example, the prevalence of hypertension was more common in this community compared to other groups. Elevated rates of other health problems, such as disability, were also apparent. In fact, nearly one-quarter of adults lived in a household with someone with some type of a disability. This is approximately 50% higher than the rate for all Jewish individuals in Chicago according to data from the MJCPS, 2000-2001. At the same time, mental health issues also deserve attention. Amazingly, over half of the respondents reported having emotional problems. Experience with depression appears to be particularly widespread. Perhaps the most striking health problems involve weight. In fact, it was discovered that over half of all adults and children were overweight. This includes a substantial proportion of individuals who were severely overweight (obese). Potential explanations for these weight problems come from data describing issues such as poor eating habits, a lack of exercise, and misperceptions about weight status. The current survey was also instrumental in collecting local data on other health-related behaviors and experiences. For example, the findings indicate

that over half of adults had not been screened for genetic disorders. Even among those of child-bearing age, the majority of single adults and nearly one-third married adults had not been screened. A more distressing finding is that a large proportion of individuals had witnessed or experienced some type of violence. These are the first population-based estimates of violence within the Jewish community in Chicago and they confirm the high rates suggested by the Task Force on Domestic Violence in the Chicago Jewish Community’s qualitative assessment. In addition to these health concerns, many of the respondents were found to have financial limitations, unmet health care needs, and other issues that could prevent them from achieving optimal levels of physical and emotional health. For example, ten percent of the adults in WRP/PP lived below the federal poverty line and an additional eight percent lived in low-income households. An even larger percentage reported having insufficient funds for such necessary items as health care, food, religious obligations, and children’s education. This percentage (45%) was much greater than the combined percentage of adults in the broader MCJPS who reported that they couldn’t “make ends meet” (2%) or that they were “just managing” (23%). Moreover, certain groups of individuals shouldered a disproportionate amount of these financial and health-related burdens. In particular, members of large families, single parents, and older adults were found to have special needs in WRP/PP. Several of these groups were also found to have high levels of economic distress in the MCJPS and they remain important targets for the provision of social services. In conclusion, this study revealed several important areas of concern, as well as areas for celebration. Access to this type of information is critical because it allows local agencies and foundations to focus their efforts on the most pressing health problems within these neighborhoods. It is hoped that this information will continue to be used to develop targeted interventions and policy changes to improve the health of individuals residing in this Jewish community.

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