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CITY OF VINELAND VINELI.ND NEW JERSEY 03360 1. History Goals and Purposes The local Board of Health of the City of Vineland was established by Ordinance 7 which was adopted according to law on Jully 15, 1952. The local Board of Health which is required-by TitLe 26 of the revised statutes functioned as an autonomous board untib the passage of Ordinance 133'in July of 1954. Legislative functions of the Board will be exercised by the City Council with administrative and executive functions to be exercised by the Department of Health's director and employees. The department continues to function in accordance with Title 26 and the Minimum Standards of Performance for Local Boards of Health, Title 8, Chapter 51 of the Administrative Code and is commonly known as the "Recognized Public Heal-th Activities and Minimum Standards of Performance for Local Boards of Health in New Jersey.•" Since the Formation of the Department of Health in 1954until present, there has only been one major structural change by Resolution of City Council (Board of Health). In June 1966, in preparation,to•meet Social Security (Medicare) requirements for home health care, Resolution 3522 was adopted. It established the new objectives for the Community Nursing Service to provide skilled nursing and other therapeutic services on a visiting basis, in addition to carrying out the preventive and health supervision services within the program areas of the Department of Health. The Director of Publlie Health Nursing of the Community Nursing Service, as a subdivision of the Department of Health,, is responsible to the Director of the Department of Health,. The Director of Nursing receives advice and oversight from the agency's Professional and Lay Advisory Committee through quarterly meetings and various committee activities. The Director of Health also serves on•this "Committee" and provides a direct link to the Mayor and City Council. The members of this Committee are nominated at large and approved by the Mayor. The Director of Nursing may approach the Mayor and Council (as a Board of Health) with budgets, problems, needs, new programs etc. either through the Director of Health or along with•him to assist with information. Advisory Committee Meetings are open to the public and both city council and the Mayor have knowledge of meeting dates and times.

PURPOSE AND PHILOSOPHY-DEPARTMENT OF HEALTH The Department of Health of the City of Vineland is one of the chief divi,sions of the city administration. It has the responsibility of executing the statutes and laws of the State of New Jker•sey as•well as the health-related ordinances of the City of Vineland. The total environment of the community affects the health•of, its citizens, which is ultimately a community affair. The Department of Health has an obligation to establish health services as designated by community need and demand. It has the responsibility to protect the environment by establishing necessary services to accomplish this end. The purpose of the Health Deoartment is to provide those services which should promote a healthy environment and, prevent disease. To accomplish its purpose, the Department is divided into personal healith (CNS),, environmental health, and statistical services. lit also maintai;ns- proper facilities, up to date personnel, and efficient record and statistical systems. COlfliUNITY NURSING SERVICE Care of patients in their home environments is an essential part of the health care system-providing an efficient and more economical means of meeting health needs--preventive, curative and rehabilitative. The public health nursing staff should responsibly provide nursing service on a family-centered basis for individuals and-groups, at home, aa work, at school and in public health clinics. Public health nursing includes all aspects of teaching, counselling, guidance, curative and preventive care, and, mobilization of family and community resources for solving of individual and famiLy health probbems.

1 GOALS-COMMUNITY NURSING SERVICE Dts purpose is to enable the citizens of the City to reach and/or mai,ntain their maximum health potential by providing health services for the prevention of disease and the treatment and/or rehabitbi,tati®n of those to whom illness and/or its complications have aDready affected. 1. To provide skilled; public health nursing to ind=viduals in the City of Vineland in their home, workplace, school or clinic facility. 2. To collect data regarding health status of individuals or populations and make this data accessible, recorded and easily communicated to health care team members. 3'. To promote, maintain and restore patient's or populations'we11 being through-approved nursing actions based on the plan for service. 4. To involve patient/community participation in his health promotion., maintenance and restoration. 5,. To evaluate, reassess and revise the initial plan and goal achievements for patient and the community. To accomplish its purpose the Community Nursing Service provides Public Health Nursing services in accordance with community needs. It maintains facilities necessary to administer these programs and employs•and maintains a staff of qualified professionals and para- professionals to administer and carry out these services. Professional nursing and other therapeutic services are rendered in clinics, conferences, school or place of residence of individual receiving the services. By Cooperating and coordinating services with other agencies and institutions, it promotes health in the community without duplication. .

3. SMOKING RELATED EXPERIENCE (CONT) In, ApriU, 1988 the Vineland; CYty Health Department received a grant from the New Jersey State Department of Health for a Smoking Preventilon Project in the Vineland City SchooLs. During the 1988-89 and b989-90 school year all 7th grade students in public and private schools were reached with a four to five d'ay smoking prevention program. During the 1988-89 school year all students were given a pre and-post test survey to determine smoking prevalence. It was found that approximately 17% of the students were already smoking in the 7th grade. During the summer of 1989 an-ad'd-itional program was added to the grant and a total of 575 preschool children in Vineland were provided with a smoking prevention program. As a result of the post test survey it was indicated that many students (617.) who smoked were interested in-quitting. During this period, the Governor signed into law a bill which would require all public schools to become smoke free before December 14, 1989. The Vineland Health Department offered smoking cessation programs to the faculty and staff and secondary school students during the 1989-90 school year. A total of 12 programs were offered to the faculty, staff arrd; two programs were offered to the students. The Vineland Health-Department worked with the staff of the Board of Education to bring more visibility to the smoking issue by sponsoring a school assembly on cigarette advertising at three of the schools, providing a table of anti-smoking materials on Great American Smokeout Day at four local schools and working with a group of students to offer a S&ve a Sweetheart campaign for the American Heart Association at three high schools. As a result of offering smoking cessation courses to the community for a three year period., many participants of these programs expressed an ongoing need for support to stay off cigarettes after the course had ended. The staff of the Vineland Health Department was instrumental in the develop- ment of a Smokers Anonymous support group. The group serves a two fold purpose: 1) to help those who have recently quit smoking remain nicotine free. 2) to help smokers quit who have been unsuccessful at other methods. 4. Experience with similar public health or public interest issues This department has been involved in public health i.ssues since its inception and in the past ten. years to a greater degree, even on a county-wide level. More specifically, two major health problems, diabetes and childhood lead poisoning, were addressed. State health department grants were received. to carry ou•t these programs to some extent county-wide. The diabetes.program cook on a regional dimension with the development of the South Jersey Educationat Consortium which involved; four counties (hospitals and health departments) and provided educational programs for health~care professionals. This group N continues to function and the diabetes programistill reaches the entire a county even 'hou?h the grant expired in 1988. The childhood lead poison .V prQventior program has allowed this health department to interact with all ~ types of providers of children-'s health care as well as housing authorities, ~ landlords, school systems, hospitals, and day care facilities. ~ ~ Fp ~ ~

4. EXPERIENCE WITH SIMILAR PUBLIC HEALTH OR PUBLIC INTEREST IISSUES(COBT) This grant has been in effect for almost seven years. Although the remainder of the county, outside of Vineland, has its own public health nurse carrying out the lead program, the tests are paid for by Vineland's grant and Vinelandl's lead nurse provides consultation to-the county health department's program staff. CANCER PREVENTION AND EARLY DETECTION The Vineland Health Department has participated;in the past with other cancer prevention activities. Eaich year the health department works in cooperation with the American Cancer Societyto provide a pap screening clinic to the community. The Vineland Health Department has recently received a grant to expand this screening program to include a comprehensive gynecological examination and mammogram free of charge to 100 women per year. A special emphasis will be placed on outreach to minority communities. Two clinics per year will be devoted to the Spanish speaking population. Two representatives from the health department are on the American Cancer Society public education committee and participate in the speakers bureau on the following topics: Nutrition and Cancer, Breast Self Examination, Fresh-Start Smoking Cessation•and colorectal cancer preventiom. CARDIOVASCULAR The Vineland Health Department had worked in cooperation with other agencies in Cumberland County to provide a Cardiovascular Disease Program to the community. The health- department provides blood pressure screenings to Vineland City residents and followtup all individuals who have elevated levels. As a part of the screening process a risk factor assessment is provided for all individuals screened. A member of the Health Department staff participates in the Cumberland County Unit of the American Heart Association and participates in the Speakers Bureau. 5. RATIONALE FOR COALITION MEMBERSHIP AND tiOW WE HAVE WORKED WITH THEM 6. HOW TARGET GROUPS WILL BE REACHED YOUTHS - each major school district superintendent will be represented on the coalition. Both health.departments have established previous rellationships with the county's schools, public and private. As stated previously the Vineland Health Department has worked within the schoob system curriculum to teach smoking prevention. The school based health service obviously addresses health needs and-probliems in youth. A representative and possibly a studene will serve om the coalition. Martin Luther King Academy for Youth will also represent the interests and issues of youth and especially the Black youth. Several employees of the MLK Academy are deeply involved with the NAACP and; Black Women's organizations. The Teen Outreach Program at Family Planning Services will also be represented on the coalition. Th-is group covers three counties-Salem, Gloucester and Cumberland. This service has developed programs to specifically address the problem of teenage pregnancies and prenatal needs including smoking and drug abuse during pregnancy.

. ~~~~t1Y AND HOW WE HAVfi WORKeD tJITH THEM(CONT) ~~ tltcOUPS W7.LI: BE REACHED SMOKELESS TOBACCO USERS - since we are not sure of the exact location of this group, we are making two assumptions for our specific county- They are, that most smokeless tobacco users are mal•e and many are associated with sports teams and can therefore be reached through the scHoo.b system. The coa•lition members mainly addressing this target group are the school system,, school based health service, Martin Luther King Academy and possibly CASA PRAC. This target group has not been as actively pursued.in the past, as the teenager or adult who smokes cigarettes, cigars, etc. BLUE COLLAR WORKERS - one of the largest industries employing blue collar workers in Cumberland County is Wheaton Industries in Millville. Coalition member- ship and a letter of support have been requested from management and the factory physiciam. Since taaagratent has requested smoking cessatiom imformation there has been some previous contact. More attempts will be made to involve all county industries, either directly or via each Ctamber of Commerce. This department has two employees who-sit on the Vineland Chamber of Commerce Health and Safety Committee. It is also expected that this group will be addressed through contact with other target groups such as women, youth, minorities and the less educated. MINORITIES - The two major IDs.uoriCy groups in•Cumberland County are the Hispanic and Black communities. The primary agency of outreach within the Hispanic community will be CASA PRAC. CASA PRAC's mission is to provide specialized services which link the Hispanic community with the resources that are needed to resolve problems. CASA PRAC's programs target Hispanics of all ages with specialized needs including senior citizens, women and children. Special programs are offered for AIDS Prevention, Drug and Alcohol Abuse . Prevention and Women's Health. The Martin Luther King Academy and Outreach Center is the primary agency of outreach for the Black community of the coalition. The King Academy is a multi-service agency serving Cumberland County. Services include Crisis Intervention, Youth Activities, Community/Neighborhood Development, Nutritional Assistance and Counseling. WOMEN - Several agencies and organizations will be involved with the coalition which serve and provide outreach to women. Both Newcomb Medical Center and the Cumberland County Health Department have a prenatal clinic. Pregnant womem wi•ll be a major target group among women for smoking cessation_ Young women, especially teenagers will be a specific target group among women of all ages. The School Based Health Services located in Bridgeton will participate in the coalition. Family Planning of Cumberland County aLso provides education and• outreach on drug and alcohol abuse and fetal alcohol syndrome through patieint counseTling and a Teen Theatre Group. The Board of Education of the three major school districts will be represented- on the coalition. Teenage girl•s will be targeted for smoking prevention/cessation using the school system as primary access to these young womem. The Vineland Health Department has worked closely with~aYl of the above agencies in the past.

5. RATIONALE FOR COALITION MEMBERSHIP AND HOF! WE HAVE WORKED WITH THEM{CONT) 6. HOW TARGET GROUPS WILL BE REACHED LESS EDUCATED - In 1986 a task force of the Human Services Advisory Council was formed to study the reasons why Cumberland County had the highest drop out rate in New Jersey. It is estimated that 20% of the students who enter ninth grade each year drop out of school by the end of 12th grade. The Task Force came up with several recommendations, one of which was to identify students at risk of-droppIng out and provide preventative measures. At the current time, CASA PRAC•has been funded to run a pilot project on drop out prevention. Another program exists in the county to identify ilLiterate adults and:teach them to read. The coalition will work cLosely with the above agencies and programs to target the less educated in Cumberland County. 7. CREATION OF A MECHANISM THAT WORRS The Vineland Health Department has a history of working with target populations utilizing their homes, schools, work sites, places of worship and recreation. Consumer participation on advisory committees and dialogues with special interest groups have allowed us to get to the people we seek and design programs to meet their needs. We will go wherever we need, at the time of day or night that will get us the population we are addressing. We are not just a nine to five, weekday department. Our programs have utilized volunteers as well as professionalls. We enjoy trying out systems that have worked in other places and will do some new things that look like they might work. S. IN KIND CONTRIBUTION ESTIMATED TIHE Alice Hart, Director of Public Health Nurses 0.5 days/week Mary Ann Cooney, MPH; Health Educator 2 days/week CLerical staff (2) 1 day/week Office supplies ie. copying, postage Office space and accompanying furniture and equipment currently in use.