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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

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


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


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


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


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


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.

http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/Appendix_A_Clinic_Mapping_Project_Report_2005.pdf


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).


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


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.


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


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).


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


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


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


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.


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