web viewkent county community analysis21. running head: kent county community analysis1
TRANSCRIPT
Running head: KENT COUNTY COMMUNITY ANALYSIS 1
Kent County Community Analysis
Group 2: Tara Braun, Stephanie Bycroft, Kristine Cargill, Jeanette Depue, Jennifer Hanson,
Laryn Phillips, Aundrea Robinson-Burris, Alicia Williamson
Nurs 340
KENT COUNTY COMMUNITY ANALYSIS 2
Abstract
The mortality rate of Kent County is highly attributable to heart disease. Modifiable risk factors
of heart disease include obesity, physical activity, nutrition, and smoking. We examined several
factors in Kent County based on several sources of statistical data to formulate an impression
about this community: Heart disease disproportionately affects the mortality rates of low-income
African Americans in the Kent County community. Heart Disease is the leading cause of death to
African Americans and at a greater rate than Caucasians in Michigan (Michigan Department of
Community Health, 2012). What is causing this disparity? What can we do to change it?
In order to appropriately answer these questions we must address these risk factors in this
population in the proper social setting. Two of the risk factors for obesity are also the risk factors
for heart disease: Physical inactivity and diet. Using Social Marketing Theory, we will discuss
heart disease and obesity in the Kent County Community.
KENT COUNTY COMMUNITY ANALYSIS 3
KENT COUNTY COMMUNITY ANALYSIS
Obesity and heart disease have high rates of incidence in the Kent County area. The
African American community has an increased prevalence of these diseases in Michigan and in
Kent County. The overall death rates of African Americans in Michigan are higher than the
national averages and the highest percentage of these deaths are attributable to heart disease
(Michigan Department of Community health 2012). The rates of obesity in Kent County have
increased from 17% in 1993 to 23.6% in 2008 (Kent County Health Department, 2010).
One of the risk factors for heart disease is obesity. 31.3% of the Michigan population is
obese compared to 27.8 % of the US population (Centers for Disease Control and Prevention,
2007). African Americans and low income residents (<$20,000) are at highest risks for obesity
and heart disease (Kent County Health Department, 2010). Obesity is a modifiable risk factor
for cardiovascular disease (Centers for Disease Control and Prevention, 2012c). Interventions to
prevent and reduce obesity in Kent County will reduce the prevalence and disparate impact of
heart disease. Low income communities that are predominantly occupied by people of color i.e.
African Americans are at greater risk for obesity than those occupied predominantly by other
races and should be targeted in an initiative to reduce heart disease (Robert Wood Johnson
Foundation, 2011). Minorities are disproportionately represented in low-income neighborhoods
and are most likely to be affected by programs that target low-income communities (Kent
County Health Department, 2005). In order to effectively reduce heart disease in low income
African American communities in Kent County, an initiative must be implemented that targets
the reduction of obesity. Physical Inactivity and diet are modifiable risk factors of obesity
(Centers for Disease Control and Prevention, 2009). Obesity, physical inactivity and diet are all
modifiable risk factors of heart disease and should be the focus of an initiative that seeks to
KENT COUNTY COMMUNITY ANALYSIS 4
reduce the prevalence of heart disease (Centers for Disease Control and Prevention, 2009). A
successful intervention will reduce the number of new cases of heart disease in the Kent County
African American community when monitored over a period of two years.
How the data compare/contrast to benchmarks
In the United States, African Americans adults are 40% more likely to have high blood
pressure. African Americans are 10% less likely than whites to have blood pressure under
control (The Office of Minority Health, n.d.). Compared to white men, African American men
were 30% more likely to die from heart disease (The Office of Minority Health, n.d.). African
Americans were 1.4 times as likely to be obese as whites in 2010 (The Office of Minority
Health, n.d.). According to The Office of Minority Health, in 2010, compared to white
Americans, African Americans were 70% less likely to engage in active physical activity (n.d.).
Deaths from heart disease and stroke are twice the rate for African Americans as compared to
whites (The Office of Minority Health, n.d.). In Kent County, data reported in 2002
approximately 6.5% resident’s age 35 and older reported to have been diagnosed with angina or
coronary heart disease. This is a lower number then the 7.1 % within the state of Michigan
(Access Kent, n.d.). In Kent County, the number of males with heart disease was greater than
females with heart disease (Access Kent n.d). Heart disease and stroke were the first and second
leading causes of death in Kent County in 2003 (Access Kent, n.d). In 2003, the heart disease
mortality rate was 206.8 deaths per 100,000 people. The rate was 202.2 in the white population,
and among African Americans the rate was 265.1 per 100,000 people (Access Kent, n.d.).
According to The Kent County Health Department 2008 Behavior Risk Factor Survey, there was
an increase in the number of obese residents from 1993 to 2008 (2010). In Kent County, 17% of
KENT COUNTY COMMUNITY ANALYSIS 5
the residents were considered obese. In 2008, the obesity rate increase to 23.6% (Kent County
Health Department, 2010).
Heart disease is the leading cause of death in the United States. In Kent County, in 2010
heart disease was the leading cause of hospitalization and death (Michigan Department of
Community Health, 2012). The rate for heart disease was greater in African American males
both in the United States and in Kent County.
What factors contribute to the identified difference?
There are many different factors that contribute to identify differences in heart disease
and obesity in the African American population. One of the contributing factors according to the
CDC are that African Americans and individuals with low incomes are much more likely to
suffer from high blood pressure, high cholesterol, heart attack, and stroke than their White and
high-income peers (Center for Disease Control and Prevention, n.d.). From 2005-2008, African
American women and men 45-75 years of age had much higher heart disease death rates than
women and men of the other races. African American women younger than 75 years of age died
more often from heart disease than white women of the same age. Similar patterns were found
for black men compared with white men (Center for Disease Control and Prevention, 2011b).
Forty-five percent of African-American adults are obese and the numbers are equally alarming
for African-American children (Center for Disease Control and Prevention, Newsroom, 2011c).
Between the years of 2007-2010 the percentage of Africa-American men 20 years and over who
are obese is 38.1% and the percentage of African-American women 20 years and over who are
obese is 54.2%, in correlation the percentage of African-American men 20 years and over with
hypertension is 37.6%, and the percentage of African-American women 20 years and over with
hypertension is 44.4% (2011c). The CDC also states that the percentage of African-American
KENT COUNTY COMMUNITY ANALYSIS 6
persons under 65 years without health insurance coverage is 20.7% (Center for Disease Control
and Prevention, n.d.).
In Kent County the accesskent.com site also shows that non-white groups have
substantially lower rates of health care coverage than their white counterparts. Obese and
overweight adults are at a higher risk than adults who are at a healthy weight to develop chronic
conditions such as high blood pressure, diabetes, gallbladder disease, osteoarthritis, and high
cholesterol. Rates of obesity are highest among Kent County adults in the lower income brackets
(< $35,000 per annum), as well as African American residents (35.2%).
One possible cause of the high rate of cardiovascular disease in African Americans is a
genetic predisposition. It is has been shown that African Americans have the highest rate of
genetic predisposition for heart disease (Wood-Moen, 2010). It is thought that the bodies of
African Americans may not be able to adequately metabolize and excrete salt compared to
Caucasians. Not being able to get rid of salt makes African Americans more sensitive to salt.
This, then, leads to high blood pressure and cardiovascular disease (WomenHeart.org, n.d.). This
genetic predisposition may be a reason why African Americans develop high blood pressure
earlier and more severely than Caucasians.
What concept model or theory might explain the difference?
In order to understand the problem of heart disease in the Kent County Community it
must be examined from the perspective of the Social Marketing Theory. Social Marketing
Theory combines the principles of several models of health behavior and applies marketing
strategies to these concepts to change social behaviors (Centers for Disease Control and
Prevention, n.d.). The community is helpful in the promotion of individual healthy behaviors;
however, it is important to understand the importance of individual choice to make changes in
KENT COUNTY COMMUNITY ANALYSIS 7
their behaviors. The Social Marketing Theory seeks to understand the individual psychological
mechanisms of change and influence individual choice from a cognitive, social and emotional
standpoint; interactions that are essential to the relationships established in the ecological model
of health promotion (Harkness and DeMarco, 2012). The correlations of these factors are
identified in The Social Marketing Theory’s application of this theory to marketing strategies
(Centers for Disease Control and Prevention, n.d.)
There are many factors that influence health behaviors: “developmental history,
psychological characteristics, interpersonal relationships, physical environment and culture”
(Harkness & DeMarco, 2012, p. 79). The Ecological Model explains that social and individual
behavior are interdependent entities that function together to create a social conundrum
(Harkness & DeMarco, 2012). The social marketing theory identifies that there are several
social influences that must be addressed from a marketing perspective to produce social change
(Centers for Disease Control and Prevention, n.d.). The 2008 Behavior Risk Factor Survey
indicated an increase in the number of obese Kent County residents from 1993 to 2008 (2010).
In 1993, 17% of the Kent County residents were considered obese and in 2008, 23.6% were
considered obese. The highest numbers of affected residents were low income and African
Americans (2010). Residents earning less than $34,999 per year had a rate of 63.7% of obesity
and 35.2 % of African Americans were obese. These statistics indicate that there are social
influences that affect health behaviors in the population of people who are African American and
the population of people who earn less than $34,999 per year: Race and Income influence social
health behaviors. Income influences insurance coverage and insurance coverage is a reliable
predictor of health status (Kent County Health department, 2005). “Thirty eight percent of the
county’s people of color population reside in these very low-income areas, while the populations
KENT COUNTY COMMUNITY ANALYSIS 8
within these census boundaries only comprise 12% of the county population” (Kent County
Health Department, 2005, p. 13). When we examine the Kent County community from the
perspective of race and areas of significant concentration we can observe a trend from the map
below; African Americans are more significantly concentrated in the inner city (Kent County
Health Department, 2005). Those citizens who meet the criteria of low-income are concentrated
more profusely between the communities primarily occupied by African Americans and
Hispanics (Kent County Health Department, 2005). 64% of the population living in low-income
neighborhoods in Kent County is non-white (Kent County health Department, 2005). Income is
a more reliable predictor of insurance coverage.
KENT COUNTY COMMUNITY ANALYSIS 9
Social cognitive theory explains that interpersonal interaction produces behavior change
(Hanan, 2009). “In order to achieve self-directed change, people need to be given, not only
reason to alter risky habit, but behavioral means, resources and social support to do so. In order
to produce social change, certain skills in self-motivation and self-guidance must be taught to the
individuals within the targeted community” (Hanan, 2009, p. 12). The community must be
presented with realistic ways to achieve optimized health. In Kent County African Americans
were not the highest race of people who reported no physical activity but report a rate of 28.6%
(2008 Behavior Risk Factor Survey, 2010). Among residents earning less than $34,999 per year,
54% of them reported no physical activity (2008 Behavior Risk Factor Survey, 2010). A
community program must use interpersonal interaction to produce community change; it must
provide a convenient and affordable support system for continued participation and follow-up
(Hanan, 2009).
The Social Ecological model of health behavior explains that there are several factors that
contribute to health behaviors. Participation, access and cost are factors that influence the
success of community interventions for health. The Centers for Disease Control and Prevention
have identified four major social issues that influence health behaviors:
The availability of healthy food and drink in schools (2011).
Absence of sidewalks and bike lanes to facilitate active transportation (2011).
Farmers markets not accepting Supplemental Assistance Nutrition Program (SNAP)
Electronic Benefits Transfer cards, which make fresh fruits and vegetables more accessible and
affordable to people in low-income neighborhoods (2011).
Lack of school programs that implement minimum physical activity requirements for
healthy living (2011).
KENT COUNTY COMMUNITY ANALYSIS 10
In order to address these issues to effectively change the health of low income African
American communities we must understand these social issues and organize an initiative to
change them. Individuals must see hope in their societal circumstances to initiate change and the
resources must be available to realistically foster an environment to change. Change happens at
the individual level and then the community level.
The Theory of Reasoned Action explains that participants must believe that their goal is
attainable; this is the primary influence of change (Harkness & DeMarco, 2012). Many
programs have been implemented to approach the problem of obesity in the Kent County
Community. There has not been an effective advertising effort linked to these initiatives to
improve participation and results; thus the foundation of the Social Marketing Model of Nursing
(Pender, Murdaugh, & Parsons, 2011, p. 51). The following graph depicts the process of health
promotion as an ongoing process with research as the center of the system. The research must be
managed effectively using several factors of community action. This ultimately results in a
continuous system of assessment, policy development and assurance that the community need to
move into the action phase of change.
http://www.slideshare.net/rcraiglefebve/social-marketing-in-a-public-health-context
KENT COUNTY COMMUNITY ANALYSIS 11
The Trans-theoretical Model addresses change and the phases of change; it examines the
process that individuals encounter and how they are approached from a behavioral standpoint to
facilitate change. In the Trans theoretical Model of behavior change the individual is analyzed
based on the stages of change (Pender et al., 2011, p. 51). As one understands the stages, they
can help an individual move through the stages of change based on the stage in which they
currently operate.
Examination of the various models and theories of social health behaviors is necessary to
understand the problems with obesity and heart disease in the African American community in
Kent County who earn less than $34,999 a year. The Social Marketing Model addresses the
concepts of various health models and theories and is best applied to this population.
What groups are particularly affected by this problem?
Obesity is a significant problem in Michigan. Michigan has one of the highest obesity
rates in the United States. Although the obesity rate in Kent County is lower than the rate in
Michigan and United States, it is still an issue. Obesity is linked to several health conditions,
including heart disease, stroke, and diabetes (Centers for Disease Control and Prevention, n.d.).
These problems that can affect any age, race, or gender; however, it is not prevalent in equal
proportions. African Americans make up less than 9% of the population in Kent County,
Michigan, but they make up 35% of the obese individuals. On the other hand, white citizens
comprise over 70% of the population, but approximately 20% of white individuals are
considered obese in Kent County (Kent County Health Department, 2010). Obesity is more
prevalent in lower income individuals and those who do not have a college degree. Men also
tend to be obese more than females.
KENT COUNTY COMMUNITY ANALYSIS 12
Heart disease, which is linked to obesity, affects African Americans more than the other
races in Kent County, next to Caucasians. Just like obesity, heart disease is also more common
in men, individuals of lower socioeconomic status, and those who do not have a college degree.
Another health condition linked to obesity is stroke and is most common in African Americans,
those of lower socioeconomic status, and those without a college education (Kent County Health
Department, 2010).
What existing resources are available to address this problem?
Of sixteen towns or cities constituting Kent County, Wyoming and Grand Rapids had the
greatest population of persons of Black race. 7.23% of Wyoming’s populations of 71,816 people
are black. 20.87% of Grand Rapids population of 190,441 people is black. For this reason, these
areas should be the focus of our intervention. This data is based on census information from
2006-2010 (World Media LLC, 2012).
Baxter Community Center aims to bring the community together. They offer sliding-fee
based health care for the uninsured and underinsured. The Healthy Weight Clinic offers Holistic
health care for adults and pediatrics (Baxter Community Center, 2012). The center is partnered
with the Helen DeVos Children’s hospital, whose goal is to decrease childhood obesity. While
this program is an awesome attempt at reaching the population in financial disparity, the hours
that it is available limit its reach. The health care clinic is open Monday-Friday from 9:00 am-
4:00 pm (Baxter Community Center, 2012).
The Millennium Park is expected to be complete by 2014, and will connect 4 cities
constituting Kent County. The goal of the park is to create sources of physical activity, such as
nature trails, bicycle paths, walkways, and beaches. The parks central location increases
availability of its resources to Kent County’s occupants (Active Living Network, 2012). The
KENT COUNTY COMMUNITY ANALYSIS 13
Robert Wood Johnson Foundation (RWJF) has a goal to “improve health and health care for all
Americans” (2012). This group is currently funding studies for preventing tobacco use and
developing methodologies to plan interventions for obesity and decrease the disparity among
racial groups. For this reason, this is likely to be one resource available for designing
intervention (Robert Wood Johnson Foundation, 2012).
The Greater Grand Rapids YMCA offers several different programs, including yoga,
zumba, basketball, and water aerobics (YMCA, 2012). They offer financial assistance for those
who cannot afford membership (YMCA, 2012). The CDC offers advice for weight management,
including portion control. To increase the effectiveness of this intervention, more people must
be made aware that it exists (Centers for Disease Control and Prevention, 2012b).
What evidence indicates that this problem is appropriate for community nursing
intervention?
Heart disease affects many people today. As of 2010, heart disease was a leading cause of
death in Kent County with the death total of 1074 residents at a rate of 178.4 per 100,000
residents (Michigan Department of Community Health, 2012). Heart disease has also accounted
for a large portion of hospitalizations. The total number of discharges in 2010 related to heart
disease was 4,890. The average length of stay for a patient admitted with heart disease
complications in 2010 was 4.6 days accounting for a total of 22,250 patient days of care related
to heart disease (Michigan Department of Community Health, 2012).
According to the 2008 Behavior Risk Factor Survey published by the Kent County
Health Department, the overall percentage of residents that reported heart disease was 4.6% with
African Americans at 4.2% (2010). Residents with an income of less than $34,999 accounted for
17.7% of reported heart disease (2010).
KENT COUNTY COMMUNITY ANALYSIS 14
There are many risk factors that contribute to heart disease. The modifiable risk factors
reviewed that are of concern for heart disease are obesity, physical activity, smoking, and
nutrition. Obesity is defined as having a body mass index, or BMI, greater than or equal to 30.
The Kent County Health Department 2008 Behavior Risk Factor Survey indicated an increase in
the number of obese Kent County residents from 1193 to 2008. In 1993, 17% of the Kent
County residents were considered obese and in 2008, 23.6% were considered obese (2010). The
highest number of affected residents was low income and African Americans. Residents earning
less than $34,999 per year had a rate of 63.7% of obesity and 35.2 % of African Americans were
obese (Kent County Health Department, 2010).
There has been a decrease in the amount of Kent County residents that have no physical
activity reported, but this issue is still of concern to the risk of heart disease in this county. The
reported overall no physical activity in 2008 was 18.0%. African Americans were not the
highest race of reported no physical activity but at a rate of 28.6% this is still an issue to this
population (Kent County Health Department, 2010). Among resident earning less than $34,999
per year, 54% of them reported no physical activity (Kent County Health Department, 2010).
Smoking has slightly increased in Kent County for 2002 to 2008 at 19.8% and 20.6%
respectively (Kent County Health Department, 2010). African Americans were the highest
reported smokers in Kent County at 38%. Low income residents were also the highest reported
group of smokers in this county at 57.9% of residents earning less than $34,999 (Kent County
Health Department, 2010).
Another risk factor for heart disease is poor nutrition. Eating five or more fruits and
vegetables per day is recommended as a part of a healthy diet. Overall, 25.7% of Kent County
residents eat five or more fruits and vegetables per day. African Americans eating this same
KENT COUNTY COMMUNITY ANALYSIS 15
account for 22.3% and low income residents account for 47.6% (Kent County Health
Department, 2010). Approximately three out of every four African Americans are not eating the
recommended amount of fruits and vegetables per day.
The modifiable risk factors of heart disease, obesity, no physical activity, smoking, and
nutrition are of concern to the community and the health of the community. Interventions
directed at changing these risk factors will inevitably decrease the rate of heart disease and
hospitalizations due to complications of this disease.
What other disciplines would be involved in addressing this problem?
In order to assist with managing obesity the entire community needs to get involved. The
community would benefit from a safe environment to promote physical activity. The CDC has a
program that provides community’s with funds to assist in nutrition and activity education. The
state also provides assistance for families to receive fresh foods such as the WIC program.
Schools should promote physical education and a safe place for exercise. They can also provide
education on fresh nutritious foods to eat as well as providing these at in student lunches. It
would also be possible to get physical therapists and dieticians to assist with education for the
community. Some of the residents may not have access to a gym but if they can learn simple
exercises they can do at home it would increase their activity. Community centers and public
transportation also need to be involved because a lack of money and transportation is a major
contributor to obesity. The health department could provide educational classes as well as
community events to promote and spread the word about obesity prevention.
What community groups could be resources in addressing this issue?
There are several resources offered in the Kent County area that can help low income
African Americans fight obesity. These classes are not specifically targeted towards African
KENT COUNTY COMMUNITY ANALYSIS 16
Americans, but Grand Rapids residents. However these programs have not shown a decrease in
obesity rates in Kent County among African Americans.
To get more support for African Americans there needs to be more involvement from
community groups that target low income African Americans. The Task Force on Health Care
for People of Color is an initiative that addresses health care issues that affect people of color
disproportionately (Kent County Health department, 2005). There are several health centers that
target low-income households in communities within the Kent County area (Kent County Health
Department, 2005). These health centers seek to improve the health of the communities where
they are located (Kent County Health department, 2005). Minorities are disproportionately
represented in low-income neighborhoods and are likely to be affected by programs that target
low-income communities (Kent County Health Department, 2005). There are 19 health clinics
involved with this initiative (Kent County Health Department, 2005). Eight clinics are run by
Cherry Street Health Services, and eight are operated by Saint Mary’s Hospital (Kent County
Health Department, 2005). Three clinics are managed by Spectrum Health and two are managed
independently at independent sites in the communities that they serve: Baxter Holistic
Community Health Center and Burton Health Center (Kent County Health Department, 2005).
These clinics serve many low income and African American families (Kent County Health
Department, 2005).
Many low income families frequent Department of Human Service (DHS) in Kent
County. It serves many communities outside of the Greater Grand Rapids area. The offices in
Kent County are located in the city of Grand Rapids. Families go there for government assistance
in times of economic difficulty. The DHS building is a part of a complex that also houses the
Women Infants and Children (WIC) office. According to Access Kent (n.d.), the WIC program
KENT COUNTY COMMUNITY ANALYSIS 17
offers, “Nutrition education, breastfeeding promotion, education and support, referrals to other
health care providers, high risk nutrition counseling, immunizations and supplemental foods.”
These organizations could help to increase awareness of the already existing resources that are
available.
There is a need to target the low-income African American Community in the Kent
County area for health intervention to reduce the prevalence of heart disease and its effects on
this population. An initiative that conglomerates the resources of the Community Health Centers
that serve the low-income communities and the resources of The Department of Human Services
in Grand Rapids will effectively address this problem. This initiative should be marketed
appropriately in these communities to optimize participation and success.
KENT COUNTY COMMUNITY ANALYSIS 18
References
Access Kent. (n.d.). What is WIC. Retrieved from
http://www.accesskent.com/Health/HealthDepartment/WIC/
Active Living Network. (2012). Millennium Park-Grand Rapids. Retrieved from
http://www.activeliving.org/node/312
Baxter Community Center. (2012). Child Development Center. Retrieved from
http://www.baxtercommunitycenter.org/prog_cdc_overview.php
Centers for Disease Control and Prevention. (2007). Surveillance of Certain Health Behaviors
Among States and Selected Local Areas: United States, 2005. Morbidity and Mortality
Weekly, 67(SS4), 1-164 Retrieved from http://www.cdc.gov/mmwr/PDF/ss/ss5604.pdf
Centers for Disease Control and Prevention. (2009). Heart disease behavior. Retrieved from
http://www.cdc.gov/heartdisease/behavior.htm
Centers for Disease Control and Prevention. (2011a). Communities putting prevention to work:
Obesity. Retrieved from
http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/program/obesity.htm
Center for Disease Control and Prevention. (2011b) Minority Health, Retrieved from
http://www.cdc.gov/minorityhealth/observances/BAA.html
Center for Disease Control and Prevention. (2011c). CDC Newsroom, African-American Media
Resources. Retrieved from http://www.cdc.gov/media/subtopic/resources/aaresource.htm
Center for Disease Control and Prevention. (2012a) FastStats, Health of Black or African
American non-Hispanic Population, Retrieved from
http://www.cdc.gov/nchs/fastats/black_health.htm
KENT COUNTY COMMUNITY ANALYSIS 19
Centers for Disease Control and Prevention. (2012b). Healthy weight- it’s not a diet, it’s a
lifestyle. Retrieved from
http://www.cdc.gov/healthyweight/healthy_eating/portion_size.html
Centers for Disease Control and Prevention. (2012c). Heart disease facts. Retrieved from
http://www.cdc.gov/heartdisease/facts.htm
Centers for Disease Control and Prevention. (n.d.). Social Marketing: Nutrition and physical
activity. Retrieved from
http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/phase1/strategy_for_change2
.htm
Centers for Disease Control and Prevention. (n.d.). [Social marketing theory process]. Social
Marketing: Nutrition and physical activity. Retrieved from
http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/phase1/strategy_for_change2
.htm
Hanan, M. (2009). Interpersonal and mass media campaign for HIV/AIDS prevention: an
integrated approach. Journal of Development Communication, 20 (1), 10-30.
Harkness, G.A., & DeMarco, R.F. (2012). Frameworks for health promotion, disease prevention
and risk reduction. In Community and public health nursing: Evidence for practice (pp.
65-85). Philadelphia, PA: Wolters Kluwer Health/ Lipincott Williams & Wilkins.
Kent County Health Department. (2010). 2008 Behavioral risk factor survey. Retrieved from
http://www.accesskent.com/Health/HealthDepartment/
Kent County Health Department Task Force on Health Care for People of Color. (2005). Clinic
mapping project report: Access to health care services. Retrieved from
KENT COUNTY COMMUNITY ANALYSIS 20
http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/
Appendix_A_Clinic_Mapping_Project_Report_2005.pdf
Kent County Health Department Task Force on Health Care for People of Color. (2005). [Spot
map comparison of minority population concentration in Kent County]. Clinic mapping
project report: Access to health care services. Retrieved from
http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/
Appendix_A_Clinic_Mapping_Project_Report_2005.pdf
Michigan Department of Community Health. (2012). Michigan critical health indicators: 2011.
Retrieved from http://www.michigan.gov/mdch/0,1607,7-132-2944_5327-
17501--,00.html
Michigan Department of Community Health. (2012). Profile of Kent County. Retrieved from
http://www.mdch.state.mi.us/pha/osr/chi/Deaths/leadfig/LeadingGraphObject.ASP?
AreaCode=41&AreaType=C&JS=No
The Office of Minority Health - OMH. (n.d.). Heart Disease and African Americans- Home
Page. Retrieved from http://minorityhealth.hhs.gov/templates/content.aspx?ID=3018
Pender, N., Murdaugh, C., & Parsons, M. (2011). Health promotion in nursing practice (6th ed.).
Upper Saddle River, New Jersey: Pearson Education, Inc.
Robert Wood Johnson Foundation. (2011). Childhood obesity. [pdf document]. Retrieved from
http://www.rwjf.org/programareas/ChildhoodObesityFramingDoc.pdf
Robert Wood Johnson Foundation. (2012). http://www.rwjf.org/en/grants.html?
k=&d=&l=MI&grant-number=&s=1
U.S. Department of Education. Accessed (2012). Retrieved from school-
district.findthebest.com/d/a/Michigan/kent-county
KENT COUNTY COMMUNITY ANALYSIS 21
WomenHeart.org. (n.d.). Why women of color may face higher risks for heart disease. Retrieved
from http://www.womenheart.org/supportForWomen/heartsmart101/mieresarticle.cfm
Wood-Moen, R. (2010). Hereditary factors in heart disease. Retrieved from
http://www.livestrong.com/article/187469-hereditary-factors-in-heart-disease/
World Media Group, LLC. (2012). Retrieved from USA.com
YMCA of Greater Grand Rapids. (2012). Retrieved from
http://www.grymca.org/programs/search/P182