The survey findings reported in this chapter are organized around the main questions included in the questionnaire. In each of the sections to follow, the overall findings for all New Jerseyans are generally presented first. Where appropriate, these findings are compared to the 1991 survey results. These findings are followed by a discussion of the results for selected groups within the population.

This chapter presents the results for different questions about the importance of various health issues. The survey used three different approaches to assess New Jerseyans' opinions on this:

Open-ended format (No response options read)
This approach requires the person who is responding to think of a "top of mind" answer to the question without any assistance from the interviewer.

Rated format (Aided with response options)
The survey participant is asked to evaluate each of twelve health issues on an importance scale. The interviewer provides the health issues and the response options for the scale.

Close-ended format (Aided with list)
The survey participant is asked to choose from among the twelve listed items.

Without being given any prompts or suggested responses, study participants were asked to name the most important health concern facing New Jersey. These "top-of-mind" answers may be less considered than responses that develop after being able to give the topic some thought, but they provide an important indication of what issues are on New Jersey's public health "radar screen." In this sense, access to or ability to pay for health care and health insurance (24%), cancer (15%), and pollution (13%) emerge as the main "top-of-mind" health issues that New Jerseyans feel are important for the state (Table 1). Other issues named include senior citizen health (7%), AIDS/HIV (5%), alcohol and drug abuse (3%), and worksite or environmental hazards (3%). One percent or less of residents name heart disease, vaccine-preventable infectious disease, child health, clean water, or sexually transmitted disease as their top "top-of-mind" health issue.

Among different New Jersey demographic groups, women (18%) are somewhat more likely than men (11%) to identify cancer as the most important "top-of-mind" health issue in the state. White residents (22%) are more concerned than black (14%) and Hispanic (12%) residents about access/ability to pay for care, whereas black (12%) and Hispanic (10%) are somewhat more likely than white residents (3%) to name AIDS/HIV as their top issue. Parents of children under age 18 (10%) are also more likely than other New Jersey adults (2%) to name AIDS/HIV. Residents age 50 to 64 (29%) comprise the cohort most concerned with access/ability to pay for care.

When this study was first conducted in 1991, the leading "top-of-mind" issues in New Jersey were access to and ability to pay for care (20%), AIDS/HIV (16%), pollution (15%), and worksite or environmental hazards (13%). Other issues that registered more than 1 or 2 percent in 1991 included senior citizen health (6%), cancer (5%), and alcohol and drug abuse (3%). Compared to eight years ago, the number of residents who currently name cancer as the most important issue is up (+10%age points), while the percentage who name either AIDS/HIV (-11%age points) or worksite/environmental hazards (-10%age points) as the state's most important health issue is down from the 1991 findings. Compared to eight years ago, perceived "top-of-mind" importance of access to and ability to pay for care and health insurance is just slightly higher. The proportions of residents currently registering their concerns about pollution, senior health, and alcohol/drug abuse are similar to the 1991 findings.

Study participants were asked to rate 12 types of health issues on a 5-point scale ranging from extremely important to not at all important. Three-fourths of all New Jersey residents rate 11 of these 12 items as "extremely" or "very" important (Table 2). These include cancer (93%), access/ability to pay for care (89%), AIDS/HIV (86%), heart disease (84%), vaccine preventable infectious disease (81%), alcohol/drug abuse (81%), sexually transmitted disease (80%), eliminating racial/ethnic differences in health status (79%), infant deaths (78%), worksite/environmental hazards (77%), and teen pregnancies (76%). Among the 12 health issues mentioned in the survey, only injuries (54%) are considered extremely or very important by fewer than 3-in-4 residents.

Isolating those residents who give each issue the highest rating of "extremely important," cancer is seen as the top issue, with more than half of New Jerseyans (55%) saying this is an extremely important health issue for the state. Nearly half also give the top rating to AIDS/HIV (47%) and access/ability to pay for care (45%). The remaining items are said to be extremely important by between 31 and 39 percent of residents, except for injuries which is considered extremely important by only 15 percent of New Jerseyans.

Generally, there are very few substantial differences in the "extremely/very important" ratings given these health issues by different demographic groups within the population. Among the small statistical differences noted are that women are more likely than men to rate each of these 12 items as extremely or very important issues. By race/ethnicity, minority residents are somewhat more likely than white residents to rate the following issues as important: AIDS/HIV (97% black and 91% Hispanic to 85% white), eliminating racial/ethnic differences in health status (89% black and 88% Hispanic to 76% white), sexually transmitted disease (90% Hispanic and 87% black to 77% white), infant deaths (90% black and 85% Hispanic to 76% white), teen pregnancy (88% Hispanic and 79% black to 74% white), and injuries (67% Hispanic and 60% black to 51% white).

By age, older residents age 65 and over are more likely than others to rate cancer (98%) and heart disease (89%) as extremely or very important, but least likely to say the same about AIDS/HIV (75%). Parents of children under age 18 are more likely than non-parents to give high importance ratings to AIDS/HIV (90% to 83%), alcohol/drug abuse (87% to 79%), infant deaths (85% to 73%), and worksite/environmental hazards (82% to 74%). Residents of New Jersey's major urban centers are more likely than other residents to give high importance ratings to access/ability to pay for care (99%), AIDS/HIV (95%), vaccine-preventable infectious disease (92%), teen pregnancy (85%), and injuries (62%).

Compared to the 1991 survey results, the percentage of New Jerseyans who consider these issues as extremely or very important is the same for 8 of these 12 items. The ratings for sexually transmitted disease (-7% age points) and AIDS/HIV (-5%age points) are down nominally, while the perceived importance of injuries has decreased by 15 percentage points. This latter trend is probably due in part to the fact that the 1991 survey included "automobile deaths, homicide, and suicide" in its description of injuries whereas the current survey does not. Also, the item on eliminating racial/ethnic differences in health status was not asked in 1991.

After rating each of the 12 health issues on importance, study participants were asked to select one as the most important for New Jersey. After considering these issues within the context of the survey, cancer (24%) emerged as the top issue -- named by 1-in-4 study participants (Table 3). Sixteen percent chose access/ability to pay for care and 15 percent choose AIDS/HIV as the most important health issue. The remaining 9 issues were each chosen by 6 percent or fewer participants as the most important issue, including: alcohol/drug abuse (6%), heart disease (5%), worksite/environmental hazards (4%), teen pregnancy (4%), sexually transmitted disease (3%), vaccine-preventable infectious disease (2%), racial/ethnic differences in health status (2%), infant deaths (1%), and injuries (<1%).

Among different demographic groups in the population, black residents are most likely to choose AIDS/HIV (40% to 25% Hispanic and 9% white) and Hispanic residents are more likely than others to choose sexually transmitted disease (12% to 5% black and 1% white) as the state's most important issue from among the 12 mentioned in the survey. Similarly, younger adults age 18 to 29 are more likely than older age cohorts to name AIDS/HIV (22%) and sexually transmitted disease (9%) as most important. Parents of children under age 18 (20%) are more likely than other residents (12%) to select AIDS/HIV as the state's most important health issue. Residents of urban areas in New Jersey are also more likely to name AIDS/HIV (25% major urban center and 21% other urban areas) as most important. Major urban center residents are also most likely among New Jerseyans to choose alcohol/drug abuse (13%) as the most important health concern.

White residents are more likely than minority residents to name cancer (29% white to 14% Hispanic and 11% black) or access/ability to pay for care (19% white to 9% Hispanic and 7% black). Also, residents age 50 to 64 (23%) are more likely than other age groups to see access/ability to pay for care as most important (compared to around 13% to 15% among other age groups). Residents of suburban and rural areas of the state are more likely than urban residents to select either cancer or access/ability to pay for care as the most important health issue in the state from among the 12 mentioned in the survey.

The rank order of these issues has changed since the 1991 study when AIDS/HIV was named as the most important issue by 35 percent of study participants. Access/ability to pay for care was ranked second at 15 percent (similar to the current standing for this health issue). Cancer as the most important issue is now ranked much higher than it was in 1991 when it was chosen by only 11 percent. On the other hand, alcohol/drug abuse (11%) and worksite/environmental hazards (7%) are now somewhat less likely to been seen as the most important health issue than they were eight years ago.

The 1999 survey included a new question asking study participants to assess the role of 11 different entities in addressing their most important health issue. Among these choices, New Jerseyans feel that doctors (86%), hospitals (85%), families (83%), and individuals (82%) are the leading entities that have an "extremely" or "very" important role in addressing the state's most important health issue (Table 4). Two-thirds or more also say that federal government (72%), state government (71%), and schools (66%) have an extremely or very important role. Six-in-ten say the same about local government (61%), and about half say the same about the role of the news media (56%), employers (55%), and churches (47%) in addressing the most important health issue.

Minority residents and urban residents are more likely than other New Jerseyans to say that each of these entities plays an extremely or very important role in addressing the health issue they name as most important. The racial/ethnic difference is largest in perceived role of schools and churches. Over 4-in-5 black (83%) and Hispanic (80%) residents feel that schools play an extremely or very important role in addressing their major health issue. Similarly, 70 percent of black residents and 64 percent of Hispanic residents say the same about the role of churches, compared to 39 percent of white residents. Also, Hispanic residents are most likely to see individuals (96%) as having an extremely or very important role, and black residents are most likely to say the same about doctors (95%) and hospitals (92%).

There are also differences in the perceived role of these 11 entities by the type of issue study participants name as the state's most important health concern:

Those who name cancer as the most important issue are more likely to feel that hospitals (95%), doctors (91%), individuals (81%), families (74%), federal government (73%), and state government (68%) play an important role in addressing this issue.

Those who cite access to or ability to pay for care as the most important issue are more likely to feel that state government (82%), hospitals (82%), doctors (80%), federal government (78%), families (77%), employers (74%), and individuals (73%) play an important role in addressing this issue.

Those who name AIDS/HIV as the most important issue are more likely to feel that doctors (97%), hospitals (95%), families (90%), individuals (87%), schools (86%), state government (74%), federal government (72%), and local government (72%) play an important role in addressing this issue.

Those who cite alcohol or drug abuse as the most important issue are more likely to feel that families (94%), individuals (93%), schools (90%), doctors (73%), hospitals (73%), state government (72%), local government (70%), the news media (68%), and churches (66%) play an important role in addressing this issue.

Those who cite heart disease as the most important issue are more likely to feel that hospitals (93%), doctors (90%), families (79%), and individuals (73%) play an important role in addressing this issue.

Those who name worksite or environmental hazards as the most important issue are more likely to feel that state government (86%), federal government (82%), employers (80%), schools (73%), the news media (72%), local government (71%), doctors (69%), and hospitals (66%) play an important role in addressing this issue.

Those who cite teen pregnancy as the most important issue are more likely to feel that families (100%), individuals (86%), schools (83%), churches (79%), and doctors (74%) play an important role in addressing this issue.

Those who cite sexually transmitted disease as the most important issue are more likely to feel that families (100%), individuals (97%), schools (95%), hospitals (92%), doctors (87%), federal government (70%), and churches (66%) play an important role in addressing this issue.

Those who name vaccine-preventable infectious disease as the most important issue are more likely to feel that families (96%), individuals (92%), doctors (81%), hospitals (73%), federal government (73%), and schools (69%) play an important role in addressing this issue.

Those who cite eliminating racial/ethnic differences in health status as the most important issue are more likely to feel that all these entities play an important role in addressing this issue, including families (95%), individuals (92%), schools (92%), employers (90%), hospitals (89%), doctors (88%), federal government (87%), state government (81%), the news media (78%), churches (76%), and local government (67%).

Finally, those who cite either infant deaths or injuries as the most important issue are more likely to feel that families (100%), individuals (100%), hospitals (100%), doctors (89%), schools (70%), and churches (68%) play an important role in addressing these issues.

A clear trend is seen when examining New Jerseyans' assessment of the state's most important health issues across the three different question formats utilized in the survey. Cancer emerges as the top issue, followed closely by access/ability to pay for care and AIDS/HIV. Injury is considered the least important of the 12 issues specifically mentioned in the survey. The remaining eight issues -- alcohol/drug abuse, heart disease, worksite/environmental hazards, teen pregnancy, sexually transmitted disease, vaccine-preventable infectious disease, racial/ethnic differences in health, and infant deaths -- cluster together after the top three issues.

The top three issues are in a slightly different order than they were in 1991, when AIDS/HIV was the top issue, followed by access/ability to pay for care, and then cancer.

The health care profession (such as doctors and hospitals) along with individuals and their families are seen as playing the most important role in addressing the majority of these health issues. Government and schools are also considered to be important players in addressing these concerns. The news media, employers, and churches are generally seen as having less of a role. However, the relative importance of each of these entities varies depending on the health issue that is named as most important.