General Recommendations

• Identify safe places to exercise in your area.
• Tell your family and friends about these safe places to exercise in your area.
• If safe places don’t exist, advocate for exercise facilities to your local major or city manager.
• Develop a community group to advocate for neighborhood safety.
• Use your community group to advocate for sidewalks, working streetlights and for access to local school gyms and facilities after school hours.
• Develop your own walking/biking club with family, friends and neighbors.
• Use your community group to advocate for more parks, trails and green places in low-income neighborhoods.

General Recommendations

• Support “Our Kitchen Table” in Grand Rapids, MI, an organization that strives to improve access to healthy foods and beverages.   oktjustice.org/
• Support other farmers’ markets in Grand Rapids, MI.                                          
  • fultonstreetmarket.org/
  • www.michigan.org/farm-markets/
  • downtownmarketgr.com/
• Get enrolled in the SNAP Program.
  • www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap
  • www.michigan.gov/dhs/0,4562,7-124-5453_5527_61231---,00.html
• Policymakers can provide financial incentives to members who establish and use farmers’ markets.
• Support local community gardens.
  • grandrapidsnaturalliving.com/grand-rapids-community-gardens/
• Ensure access to places with healthy options through shuttles and bus routes.
• Be aware of the “Let’s Move” Campaign.    www.letsmove.gov/make-healthy-food-affordable-and-accessible
• Implement a local ordinance to provide healthy food choices in all places (e.g., health care centers, schools, work sites, daycare centers, grocery stores).
• Support nutrition education programs.                      
  • www.unitedway.org/pages/kids-get-fit-cac-healthyfood
  • www.grymca.org/community-programs/community-based-programs/cooking-matters-program/
• Join with other community members to increase access to healthy foods.   
  www.unitedway.org/pages/kids-get-fit-cac-healthyfood

General Recommendations

• Use public transit if possible.
• Turn off lights when you’re done using them.
• Don’t burn garbage.
• Reduce the use of aerosols.
• Avoid the burning of wood.
• Avoid the use of gas-powered tools.
• Review these tips on indoor air quality.   www.epa.gov/iaq/is-imprv.html
  • Vacuum and mop frequently.
  • Keep humidity between 30-50%.
  • Make your home a no-smoking zone.
  • Get your home tested for radon gas.   www.epa.gov/radon/radontest.html
• See these tips on outdoor air quality.   www.epa.gov/air/community/
  • Don’t idle your car.
  • Limit the use of gas equipment such as lawnmowers and barbecues.
  • Turn off lights and electronics that you’re not using.
  • Use energy-efficient appliances.
  • Compost leaves, garden clippings, and kitchen waste

General Recommendations

• If concerned, visit your doctor to see if you have asthma.
• If you have asthma, know and avoid your asthma triggers. www.cdc.gov/asthma/triggers.html
• Take your medication exactly as your doctor instructs.
• Follow the asthma action plan developed by you and your doctor.
  www.webmd.com/asthma/guide/developing-an-asthma-action-plan
• Know how to properly use a peak flow meter. www.webmd.com/asthma/guide/peak-flow-meter
• Pay close attention on how to use rescue inhalers.
• Get the flu vaccine. www.cdc.gov/flu/asthma/

www.cdc.gov/asthma/

Policy Recommendations

• Improve and maintain air quality in all facilities that serve children (e.g. schools, childcare centers, after-school programs), and enforce equal air quality standards in low-income areas (PolicyLink, 2002).

• The Air Quality Index provides a forecast of the air quality, and policies should seek to reduce the number of action days (or unhealthy breathing days). Stricter industrial/manufacturing regulations may be necessary to reduce emissions near residential areas. www.airnow.gov/

• Air quality monitoring sites (2 in Grand Rapids, MI) can be found at: www.michigan.gov/deq/0,4561,7-135-3310_70310_70316_4195---,00.html

• The National Ambient Air Quality Standards (NAAQS) can be found at: www.epa.gov/air/criteria.html

www.policylink.org/sites/default/files/FIGHTINGCHILDHOODASTHMA_FINAL.PDF

Program Recommendations

• Expand the rights of public housing tenants for remediation of housing condition issues, and establish a litigation fund that will provide for the assistance of public interests attorneys seeking to enforce polices regarding the correction or remediation of public housing conditions that contribute to asthma exacerbation (PolicyLink, 2002).    www.policylink.org/sites/default/files/FIGHTINGCHILDHOODASTHMA_FINAL.PDF

• Provide low-cost, or free in-home inspections to identify known asthma triggers, and offer guidance, or incentives to improve the housing environment to reduce asthma triggers in the home (Guide to Community Preventive Services, 2008).     www.thecommunityguide.org/asthma/multicomponent.html

General Recommendations

• Don’t drink or drive or let your friends drink or drive.
• Know your limitations with alcohol consumption.
• Don’t share drinks with others.
• Know the signs and symptoms of alcohol abuse.    ncadd.org/learn-about-alcohol/signs-and-symptoms
• Learn how excessive alcohol use affects men’s health.    www.cdc.gov/alcohol/fact-sheets/mens-health.htm
• Learn how excessive alcohol use affects women’s health.    www.cdc.gov/alcohol/fact-sheets/womens-health.htm
• Policymakers can regulate the number and density of alcohol outlets in the city.
• Policymakers can increase the tax of alcohol products to discourage its usage.
• Policymakers can enforce laws to prohibit the sale of alcohol to minors.
• Parents should discuss the risks of alcohol consumption with their kids.
• Schools can implement substance abuse programs that are age specific.
• Organizations can provide peer mentoring and leadership opportunities.
• For local help, contact these treatment programs in Grand Rapids, Michigan.
  • Network180  (616) 336-3909     www.network180.org/en/substance-use-disorders/programs/treatment-services
  • West Brook Recovery Center (616) 957-1200   www.westbrookrecovery.com/

www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

Policy Recommendation

• Increasing the excise tax and restricting/reducing the number of establishments that can sell alcohol, have been found to reduce binge drinking, reduce youth alcohol consumption, fewer automotive accidents and impaired driving, less mortality from liver cirrhosis, and reduced all-cause mortality (Guide to Community Preventative Services, 2007; Staras et al., 2014; Xuan et al., 2015)

www.thecommunityguide.org/alcohol/increasingtaxes.html

General Recommendations

• Women, between 50-74 years of age, should get mammograms every two years.
• Consult with your doctor about additional testing.
• Visit the Betty Ford Diagnostic Breast Center for local support.
  www.spectrumhealth.org/body_locations.cfm?id=638&action=detail&ref=3091&CFID=36725856&CFTOKEN=81489169
• Know your family history of breast cancer.
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Refrain from smoking or using tobacco.
• Exercise at least four hours a week.
• Get free support to cope with the challenges of breast cancer. www.cancercare.org/diagnosis/breast_cancer
• Don’t drink alcohol or limit your consumption to one drink per day.
• If possible, breastfeed your babies.
• Avoid exposure to carcinogens or chemicals that cause cancer.
• Get enough sleep. www.cdc.gov/sleep/about_sleep/how_much_sleep.htm

www.cdc.gov/cancer/breast/

www.cancer.org/cancer/breastcancer/

General Recommendations

• Know how to properly handle breast milk.   www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
• Don’t forget to breastfeed when traveling.
• Know how vaccines affect the safety of breast milk.   www.cdc.gov/breastfeeding/recommendations/vaccinations.htm
• Know these breastfeeding tips.   www.womenandinfants.org/newbornhealth/breastfeeding-tips.cfm
• Policymakers can create policies to make breastfeeding more acceptable in public.
• Employers and policymakers can create ways to let working mothers be with their babies.
• Health care settings can provide a lactation consultant on patient care teams.
• Take a breastfeeding class in Grand Rapids, Michigan.    babybelovedinc.com/classes
• Contact the Promotion, Education and Support Center at the Kent County Health Department at (616) 632-7100.  
  www.accesskent.com/Health/WIC/breastfeeding.htm

www.cdc.gov/breastfeeding/

General Recommendations

• Be aware of the resources in your community.                                                      
  • Helen DeVos Children’s Hospital--Child Protection Services   www.helendevoschildrens.org/child-protection
• Report suspected abuse or neglect.                                                  
  • National Child Abuse 24/7 hotline: 1-800-4-A-CHILD (422-4453)
• Educate children to understand and report abuse.
• Families should strive to have strong, supportive family environments and social networks.
• Guardians should provide household rules.
• Guardians should strive to have stable relationships.
• Guardians should have employment and adequate housing.
• Guardians should know how to handle child abuse disclosures.   
  www.childhelp.org/story-resource-center/handling-child-abuse-disclosures/
• The city manager can place Family Resource Centers in low-income areas.
• Teachers and parents can teach protection and safety skills to children.
• Schools should offer home visitation programs.

www.cdc.gov/ViolencePrevention/childmaltreatment/

General Recommendations

• Get temporary cash assistance.   www.michigan.gov/dhs/0,4562,7-124-5453_5526-21229--,00.html
• Review this information on the “Friend of the Court” option.   www.accesskent.com/Courts/FOC/
• See if you qualify for child care assistance.   
  www.michigan.gov/dhs/0,4562,7-124-5529_7143-15306--,00.html
• Learn about child health insurance in Michigan – MIChild.   
  www.michigan.gov/mdch/1,1607,7-132-2943_4845_4931---,00.html
• Check out this resource on early childhood education.   www.greatstarttoquality.org

General Recommendations

• Know your partner’s STD status.
• Practice abstinence.
• Limit your number of sex partners.
• Use a new latex condom correctly every time you have sex.   www.cdc.gov/condomeffectiveness/brief.html
• If you have chlamydia or suspect you might, there is treatment for it.  Visit your local doctor for testing and treatment.

www.cdc.gov/std/chlamydia/

Policy Recommendations

• Increasing the excise tax on alcohol has been associated with a reduction in alcohol-related risky behavior, which has been found to reduce the contraction of certain STIs, including chlamydia and gonorrhea (Staras, Livingston, Christou, Jernigan, & Wagenaar, 2014).

• Enact a policy that provides structural-level condom distribution intervention, such as having free condoms available in the nurse’s office in public schools, to increase access to condoms, ensure proper understanding of use, and to enhance sexual education.  Providing interaction with the student is more effective than providing condoms alone, but both methods were found to increase condom use, and decrease contraction of STIs (Charania et al., 2011).  Other interventions include: condom informational booths, condom vending machines in restrooms, and group meetings to ensure access and proper use of condoms.

• Incorporate a health center into all middle- and high-schools, proving sexual health education, information, and counseling, as well as providing condoms, and instruction on proper use, to students.

www.advocatesforyouth.org/publications/449-school-condom-availability

Program Recommendations

• Provide comprehensive, age-appropriate sexual education in public schools which includes a heirarchy for risk behaviour, including abstinence as the best protection from STIs, as well as safe sex instruction and education (Guide to Community Preventive Services, 2009).

See: www.advocatesforyouth.org/publications/2094 for 36sexual education programs (school-, community-, and clinic-based) that have been proven to be effective.

Also see: www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/db/tpp-searchable.htm for an additional list of evidence-based sexual health and education programs. 

www.thecommunityguide.org/hiv/riskreduction.html

General Recommendations

• Find out where to register to vote and about polling locations.   
  www.accesskent.com/Departments/Elections/voting.htm
• Vote in all elections.
• Volunteer for a local event or organization of your interest.
• Utilize local resources and information from universities and institutions.  
• Support the development of local leadership.
• Advocate and donate time and resources to local health organizations.
• Get involved in a neighborhood association.
• Develop a community group and advocate for desired policies and programs with your city’s leadership.
• Help homeless families by volunteering at a local shelter.                                       
  • www.meltrotter.org/volunteer_1
  • www.safehavenministries.org/volunteer
  • www.familypromisegr.org/volunteer
  • www.lifeonthestreet.org/?q=volunteer
  • www.kidsfoodbasket.org/volunteer/volunteer

General Recommendations

• Brush your teeth at least twice a day  
• Use fluoride toothpaste to strengthen enamel and gum  
  www.ada.org/en/science-research/ada-seal-of-acceptance/product-category-information/toothpaste
• Know and use proper brushing techniques  
  www.colgate.com/en/us/oc/oral-health/basics/brushing-and-flossing/article/how-to-brush
• Keep your equipment clean  
  www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-toothbrush-care-cleaning-storage-and-
• Replace your toothbrush every three months  
  www.everydayhealth.com/dental-health/how-often-should-you-replace-your-toothbrush.aspx
• Flossing at least once a day       www.mouthhealthy.org/en/az-topics/f/flossing
• Get regular check-up every 6 months  
  www.dentalcare.com/en-US/dental-education/patient-education/regular-english.aspx
• Eat rich nutrient foods and limit snacks/sweets

www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20045536

www.marshfieldclinic.org/specialties/dental-care/dental-why-important

General Recommendations

• If feeling depressed, visit your doctor for a consultation.
• Know these symptoms of mental illness.    
  www.mayoclinic.org/diseases-conditions/mental-illness/basics/symptoms/con-20033813
• Pay close attention to warning signs of depression.
• If diagnosed with depression, take your medication consistently and correctly.
• Try to avoid drugs and alcohol that may make your depression worse. 
• Try these mental health-screening tools, but these should not replace a doctor’s visit.   
  www.mentalhealthamerica.net/mental-health-screening-tools
• Review these general health resources on mental health.   www.cdc.gov/mentalhealth/gen-resources.htm
• Find behavioral health treatment services in your area.   findtreatment.samhsa.gov/

www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm

General Recommendations

• If you’re a diabetic, take your medication as prescribed by your doctor.
• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk and cheese. 
• Stay at a healthy weight. Consult your doctor to learn more about a healthy weight for you.
• If you are pre-diabetic, try to lose 5%-7% of your body weight. 
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Maintain a healthy support system with your family, friends and health care providers.
• Refrain from smoking or using tobacco. www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm
• Reduce your alcohol intake.

ndep.nih.gov/i-have-diabetes/manageyourdiabetes.aspx

www.cdc.gov/diabetes/home/index.html

Program Recommendation

• Provide access to neighbourhood or community-level diet and physical activity promotion programs, with an emphasis on prevention or control of diabetes (Guide to Community Prevention Services, 2014).

www.thecommunityguide.org/diabetes/combineddietandpa.html

General Recommendations

• Get and maintain health insurance.
• Get an annual physical.
• Be active every day.
• If possible and safe, adults with disabilities should try getting 2 hours and 30 minutes per week of moderate physical activity (i.e., wheeling yourself in a wheelchair, brisk walking).
• Don’t smoke or consume tobacco.
• Limit alcohol consumption.
• Eat healthy foods and beverages in healthy portions.
• If necessary, seek health for substance abuse.
• Take any prescribed medication as directed by your doctor.
• Get help if you are abused or harmed.
  • Call the National Domestic Violence hotline at: 1-800-799-SAFE or 1-800-787-3224.
• Maintain contact with some family and friends.

www.cdc.gov/ncbddd/disabilityandhealth/healthyliving.html

General Recommendations

• Don’t drink or drive or let your friends drink or drive.
• Know your limitations with alcohol consumption.
• Don’t share drinks with others.
• Know the signs and symptoms of alcohol abuse.    ncadd.org/learn-about-alcohol/signs-and-symptoms
• Learn how excessive alcohol use affects men’s health.    www.cdc.gov/alcohol/fact-sheets/mens-health.htm
• Learn how excessive alcohol use affects women’s health.    www.cdc.gov/alcohol/fact-sheets/womens-health.htm
• Policymakers can regulate the number and density of alcohol outlets in the city.
• Policymakers can increase the tax of alcohol products to discourage its usage.
• Policymakers can enforce laws to prohibit the sale of alcohol to minors.
• Parents should discuss the risks of alcohol consumption with their kids.
• Schools can implement substance abuse programs that are age specific.
• Organizations can provide peer mentoring and leadership opportunities.
• For local help, contact these treatment programs in Grand Rapids, Michigan.
•           Network180  (616) 336-3909     www.network180.org/en/substance-use-disorders/programs/treatment-services
•           West Brook Recovery Center (616) 957-1200   www.westbrookrecovery.com/

www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

General Recommendations

• If a threat presents itself, call 911 or your local police department.
  • Grand Rapids Police Department: 616-456-3403
• Make sure youth have positive ways to spend their time by offering sporting leagues, volunteer opportunities, part-time jobs and hobbies.
• Provide safe routes to school for kids.
• Seek help if your domestic partner is violent or abusive.   www.thehotline.org/help/for-abusive-partners/
• Set up a Neighborhood Watch group.
• Talk to a domestic violence lawyer in Grand Rapids, MI.   
  www.lawyers.com/domestic-violence/grand-rapids/michigan/law-firms/
• Prisons can provide education and skill training to prisoners to help them obtain employment upon release.
• The city council can provide resources to help ex-offenders find secure living wages and housing, so they are less likely to repeat crimes.
• Establish drug-free and gun-free zones within your community.
• Hold public forums, so citizens can voice their issues to local police to help build trust.

blog.metrotrends.org/2013/05/ways-reduce-crime/

General Recommendations

• Get health insurance.
• Get annual physicals.
• Know your family history of illness or disease.
• Know your health status and any illnesses.
• Take any prescribed medication as instructed by your doctor.
• Don’t ignore any health problems or concerns.
• Review different health insurance plans with a trained professional to learn the best one for you.
• Get a ride to your doctor.   www.lakeshoreridelink.org/
• Check out these health care and insurance companies.
  • Mercy Health   www.mercyhealthsaintmarys.com/welcometosaintmarys
  • Cherry Health   www.cherryhealth.org/about/
  • Spectrum Health   www.spectrumhealth.org/
  • Heartland-ManorCare   
    www.heartland-manorcare.com/find-a-location/locations/heartland-health-care-center-grand-rapids/
  • Health Intervention Services   www.hisgr.org/
  • Community Home Health Care Services   www.visitingnurse.com/mi/

General Recommendations

• Get health insurance.
• Visit this website to apply for health insurance.   www.healthcare.gov/
• Review different health insurance plans with a trained professional to learn the best one for you.
• Get annual physicals.
• Know your family history of illness or disease.
• Know your health status and any illnesses.
• Take any prescribed medication as instructed by your doctor.  
• Don’t ignore any health problems or concerns.
• Get a ride to your doctor.   www.lakeshoreridelink.org/
• Check out these health care and insurance companies.
  • Mercy Health   www.mercyhealthsaintmarys.com/welcometosaintmarys
  • Cherry Health   www.cherryhealth.org/about/
  • Spectrum Health   www.spectrumhealth.org/
  • Heartland-ManorCare   
    www.heartland-manorcare.com/find-a-location/locations/heartland-health-care-center-grand-rapids/
  • Health Intervention Services   www.hisgr.org/
  • Community Home Health Care Services   www.visitingnurse.com/mi/

General Recommendations

• Refrain from smoking or tobacco use.
• Know and monitor your blood pressure and cholesterol levels. A doctor can check both.
  www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Family-History-and-Heart-Disease-Stroke_UCM_442849_Article.jsp
• Know the signs and symptoms of a heart attack. www.cdc.gov/heartdisease/signs_symptoms.htm
• Know the signs and symptoms of a stroke. www.cdc.gov/stroke/signs_symptoms.htm
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk and cheese.
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Get regular health screenings.
• Reduce your stress levels.
• Take medication prescribed by your doctor for hypertension, cholesterol or diabetes.
• Get enough sleep. www.cdc.gov/sleep/about_sleep/how_much_sleep.htm

www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Assess-Your-High-Blood-Pressure-Related-Risks_UCM_301829_Article.jsp

www.cdc.gov/dhdsp/

Program Recommendations

• Develop a program that can help reduce the out-of-pocket costs for medications, behavioral counseling (e.g. nutrition counseling) and behavioral support (e.g. community-based weight management programs, gym memberships) to control high blood pressure, high cholesterol, and other factors associated with cardiovascular disease mortality. Affordable diabetes management and tobacco cessation programs are also important for reducing the risk of heart disease mortality and morbidity.  www.thecommunityguide.org/cvd/ROPC.html                              

• Engage community health workers to help increase screening, education, outreach to increase self-reported health behaviors, patient navigation, community organization, and to partner with patients and licensed professionals to increase prevention and decrease mortality and morbidity from CVD (Guide to Community Preventative Services, 2015).   www.thecommunityguide.org/cvd/CHW.html

General Recommendations

• Consume healthy foods – plant based diet to reverse the arterial blockage
• Reduce salt (sodium) intake        www.kidney.org/news/ekidney/june10/Salt_june10
• Exercise regularly to about 150 minutes per week
• Lose 5-10 percent of body weight  
  www.obesityaction.org/educational-resources/resource-articles-2/general-articles/benefits-of-5-10-percent-weight-loss
• Refrain from smoking
• Drink alcohol in moderation  
  healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/drink-alcohol-only-in-moderation
• Exercise regularly to about 150 minutes per week  
  www.everydayhealth.com/high-cholesterol/fitness-and-cholesterol.aspx
• Get regular health check-ups      www.cdc.gov/family/checkup/
• Take medications if prescribed by your doctor
• Reduce stress levels   www.helpguide.org/articles/stress/stress-management.htm

www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-Blood-Pressure_UCM_002050_Article.jsp#.Vly6tumLGAY

www.ghc.org/all-sites/guidelines/hypertension.pdf

www.cdc.gov/bloodpressure/

www.nursingtimes.net/the-importance-of-blood-pressure-control/199429.fullarticle

General Recommendations

• Refrain from smoking
• If you are going to consume alcohol, drink in moderation  
  healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/drink-alcohol-only-in-moderation
• Lose 5-10 percent of body weight  
  www.obesityaction.org/educational-resources/resource-articles-2/general-articles/benefits-of-5-10-percent-weight-loss
• Consume healthy foods and beverages        www.drweil.com/drw/u/ART03028/High-Cholesterol.html
• Be aware of the serving sizes and nutrients for healthy food intake (journaling on food intake and physical activity might help to reflect on)
• Exercise regularly to about 150 minutes per week  
  www.everydayhealth.com/high-cholesterol/fitness-and-cholesterol.aspx
• Get regular health check-ups       www.cdc.gov/family/checkup/
• Take medications if prescribed by your doctor
• Find out your blood pressure and BMI
• Reduce stress levels      www.helpguide.org/articles/stress/stress-management.htm

www.hopkinsmedicine.org/digestive_weight_loss_center/conditions/high_cholesterol.html

www.cdc.gov/cholesterol/what_you_can_do.htm

www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf

www.drweil.com/drw/u/ART03028/High-Cholesterol.html

www.mipcc.org/sites/mipcc.org/files/u4/ASK%20About%20triglcy%20and%20chol.pdf

General Recommendations

• Use a new condom correctly every time you have sex.   www.cdc.gov/condomeffectiveness/brief.html
• Limit your number of sex partners.
• Know your partner’s HIV and STD status.
• Refrain from high-risk sexual behavior.
• If you have a positive HIV status, share your status with your partner before engaging in future intercourse.
• If you have a positive HIV status, take your medication correctly and consistently.
• Never use or share needles.
• Here are frequent questions and answers on HIV prevention.   www.cdc.gov/hiv/basics/prevention.html
• Get counseling, testing and treatment in Kent County, Michigan.  www.accesskent.com/Health/PersonalHealth/
• Here are locations in Grand Rapids, Michigan to get tested for HIV.   
  samedaystdtesting.com/testing-clinics/michigan-mi/grand-rapids-std-testing
• Receive free HIV testing at Grand Valley State University.   www.gvsu.edu/events/free-hiv-testing-2/

www.cdc.gov/hiv/

Policy Recommendations

• Increasing the excise tax on alcohol has been associated with a reduction in alcohol-related risky behavior, which has been found to reduce the contraction of certain STIs, including chlamydia and gonorrhea (Staras, Livingston, Christou, Jernigan, & Wagenaar, 2014).

• Enact a policy that provides structural-level condom distribution intervention, such as having free condoms available in the nurse’s office in public schools, to increase access to condoms, ensure proper understanding of use, and to enhance sexual education.  Providing interaction with the student is more effective than providing condoms alone, but both methods were found to increase condom use, and decrease contraction of STIs (Charania et al., 2011).  Other interventions include: condom informational booths, condom vending machines in restrooms, and group meetings to ensure access and proper use of condoms.

• Incorporate a health center into all middle- and high-schools, proving sexual health education, information, and counseling, as well as providing condoms, and instruction on proper use, to students.

www.advocatesforyouth.org/publications/449-school-condom-availability

Program Recommendations

• Provide comprehensive, age-appropriate sexual education in public schools which includes a heirarchy for risk behaviour, including abstinence as the best protection from STIs, as well as safe sex instruction and education (Guide to Community Preventive Services, 2009).

See: www.advocatesforyouth.org/publications/2094 for 36sexual education programs (school-, community-, and clinic-based) that have been proven to be effective.

Also see: www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/db/tpp-searchable.htm for an additional list of evidence-based sexual health and education programs. 

www.thecommunityguide.org/hiv/riskreduction.html

General Recommendations

• Know the recommended vaccinations for children 0-6 years of age.
  www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf
• Know the recommended immunization schedule for persons 0-18 years old. 
  www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
• Realize the importance of getting your child immunized.   www.cdc.gov/vaccines/vac-gen/why.htm
• Know your local immunization locations and schedules.
• Kent County Health Department (616) 632-7100  www.accesskent.com/Health/Immunizations/default.htm
• You can also contact your pediatrician’s office.
• Know your child’s vaccination history during all health care encounters.

www.cdc.gov/vaccines/default.htm

Program Recommendation

• Provide incentives to families, monetary or non-monetary, to increase the vaccination rates of their children (Guide to Community Preventatives Services, 2015).

Non-monetary incentive examples include: baby/child products (e.g. diapers, formula) and food vouchers.

www.thecommunityguide.org/vaccines/incentiveRewards.html

• Develop a program that provides an in-home vaccination services for those that are unable to bring their children to the hospital or a clinic. Any fees incurred could be based on a sliding scale to help ensure low-income families are properly vaccinating their children (Guide to Community Preventative Services, 2009).

www.thecommunityguilde.org/vaccines/homevisits.html

General Recommendations

• Maintain connections with close family or friends.
• Don’t isolate yourself too much from family or friends.
• Try to join a community group or organization to build friendships.
• See if any of these social organizations in West Michigan interest you.
  www.grnow.com/index.php?option=com_content&task=view&id=1823
• Check out these community events in Grand Rapids, Michigan.   www.downtowngr.org/events.php?date=today
• Visit the social websites in your area for upcoming events.

General Recommendations

• All women of childbearing age should consume 0.4mg (400 micrograms) of folic acid every day.  
  www.cdc.gov/ncbddd/folicacid/recommendations.html
• Below is the recommended amount of folic acid women should consume based on their pregnancy status:   
  www.webmd.com/baby/folic-acid-and-pregnancy
  • While you're trying to conceive: 400 mcg
  • For the first three months of pregnancy: 400 mcg
  • For months four to nine of pregnancy: 600 mcg
  • While breastfeeding: 500 mcg   
• Refrain from smoking or using tobacco. 
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Consult your doctor about medications or immunizations that you need or may be taking. 
• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk and cheese.
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Try to prevent closely spaced births or wait at least 18-24 months before attempting your next pregnancy.
• Don’t consume excessive amounts of alcohol.
  • Excessive amounts of alcohol for women is defined as: women who drink 4 alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as women who drink more than 1 drink per day on average. 
• Don’t use street drugs.
• Brush your teeth twice and floss daily. See a dentist.

Program Recommendation

• Provide physical informational material for new parents available at hospitals prior discharge, as well as the local health departments, and other health clinics.  This information should include, but not be limited to, the correct way to lay down a baby for sleeping, how to properly hold and support an infant, the benefits of breastfeeding as well as information for alternatives to breastfeeding, and the proper use of child seats in vehicles. This information can help ensure parents have access to this information, whether they have internet access or not, and to serve as helpful reminders of any informational discussions they may have with physician(s) prior to discharge from the hospital with their newborn. There could also be a link to a credible website with this information, for those that have internet access.

General Recommendations

• Wear your seatbelt at all times.
• Put babies in child safety seats.
• Make sure smoke alarms are installed and working properly in your home.
• Parents should monitor their kids when they’re driving.
• Don’t drink and drive or let your friends drink and drive.
• Don’t text while driving.
• Join community groups and advocate for better roads and highways.
• Make sure your doctor follows guidelines for prescribing painkillers.
• When riding a motorcycle or bike, wear a helmet.
• Learn life-saving skills like CPR and swimming.  grhealthcare.blueskygr.com/index.html
• Ensure that the elderly have fall-safe living arrangements.
• Make sure kids wear life jackets when near water. 

www.cdc.gov/injury/

Policy Recommendation

• Stricter enforcement and penalties for seat belt and car-seat-laws to ensure adequate protection during motor vehicle accidents, and to decrease non-compliance.

General Recommendations

• Refrain from smoking or using tobacco.
• For quitting support, visit www.smokefree.gov.  You can also call 1(800) QUIT-NOW (784-8669) or text “QUIT” to 47848 from your cell phone.
• Get your home tested for radon.   www.epa.gov/radon/pubs/citguide.html#howtotest
• Avoid secondhand smoke exposure.
• Avoid exposure to carcinogens or chemicals that cause cancer (especially in some work areas).

www.cdc.gov/cancer/lung/

Policy Recommendations

• Expand HUD's mandatory radon testing for multi-dwelling family units to all rental units, and encourage low-cost radon testing for all housing that is not rental property. Home test kits for radon gas are available at the Kent County Health Department, Environmental health Division, 700 Fuller N.E. Cost: $5.00. Call (616) 632-6900 for more information.

• Strictly enforce the current public smoking ban, and restrict tobacco smoking from within 25ft of all non-residential building entrances.  Citation profits could help provide for a tobacco cessation program such as the Michigan Tobacco Quitline (michigan.quitlogix.org/).

• Increase tobacco excise taxes to reduce youth and adult tobacco use.  Increased revenue from tobacco sales can help fund and support tobacco education and cessation programs.

Program Recommendation

• Tobacco cessation program funding

General Recommendations

• Surround yourself with family and friends who are supportive and positive.
• If interested in getting your GED, take GED preparation classes.  www.grps.org/ged-classes
• To take the GED in Grand Rapids, Michigan, visit the Testing Center.  www.grps.org/ged-testing-center
• To gain workforce training, visit the Grand Rapids Community College Workforce Training site.   
  www.grcc.edu/workforcetraining
• If interested, learn English for free as a second language.   www.grps.org/adult-education-esl
• Visit GVSU’s Center for Adult and Continuing Studies to learn more.   www.gvsu.edu/learn/
• Get education support at the Conductive Learning Center.   conductivelearningcenter.org/about/
• Get education support at the National Education Association.   www.nea.org/
• Get education support at the National Educational Services.   www.nesgroup.us/

General Recommendations

• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk or cheese.
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Refrain from smoking or using tobacco.
• Reduce your alcohol intake.
• Know your Body Mass Index (BMI).    
  www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
• Reduce your screen time in front of computers and televisions.
• Understand healthy portion sizes of foods and beverages.   
  www.cdc.gov/healthyweight/healthy_eating/portion_size.html
• Drink plenty of water.  Learn how much.   www.cdc.gov/healthywater/drinking/nutrition/
• Eat healthy meals and snacks.   
  www.webmd.com/food-recipes/features/the-best-healthy-snacks-in-your-supermarket
• Be consistent with your health routine.
• Join a walking/biking group at your job or in your neighborhood. 
• Surround yourself with others who are interested in a healthy lifestyle.
• Shop around the perimeter of the grocery store for healthy foods.
• Consume foods with less sodium and fat.

www.cdc.gov/nccdphp/DNPAO/

www.cdc.gov/obesity/

Policy Recommendations

• Identify zoning regulations that create a balance between the number of fast-food restaurants and grocery stores in a community, to increase access to healthy foods, especially those within walking distance of neighborhoods.  Incentives may help foster the development of grocery stores in these areas, including smaller, health-food stores (PolicyLink, 2008).

• Require 150min per week of school-based physical education for grades K-5, and 225min for intermediary and high-school students, as recommended by the National Association of Sport and Physical Education.  According to the CDC (2015), children should participate in 60+ minutes of physical activity each day, with three of those days including bone-strengthening activities (e.g. jumping rope, basketball, hopscotch), and three days including muscle-strengthening activities (e.g. playing on playground equipment, tug-of-war).  Physical education classes should incorporate activities that children can utilize outside of class, to increase physical activity, and help meet the recommended 60+ minutes of activity each day.  Additionally, providing access to playgrounds after school hours, including supervision immediately following school hours, can encourage physical activity in children, as well as providing funding for extracurricular activities outside of school, especially for low-income families that cannot afford the fees and equipment costs (Guide to Community Preventative Services, 2013).

General Recommendations

• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk or cheese.
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Refrain from smoking or using tobacco.
• Reduce your alcohol intake.
• Know your Body Mass Index (BMI).    
  www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
• Reduce your screen time in front of computers and televisions.
• Understand healthy portion sizes of foods and beverages.   
  www.cdc.gov/healthyweight/healthy_eating/portion_size.html
• Drink plenty of water.  Learn how much.   www.cdc.gov/healthywater/drinking/nutrition/
• Eat healthy meals and snacks.   
  www.webmd.com/food-recipes/features/the-best-healthy-snacks-in-your-supermarket
• Be consistent with your health routine.
• Join a walking/biking group at your job or in your neighborhood. 
• Surround yourself with others who are interested in a healthy lifestyle.
• Shop around the perimeter of the grocery store for healthy foods.
• Consume foods with less sodium and fat.

www.cdc.gov/nccdphp/DNPAO/

www.cdc.gov/obesity/

General Recommendations

• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Review these guidelines on how much physical activity you need a week.   
  www.cdc.gov/physicalactivity/everyone/guidelines/index.html
• Review these examples on how to get sufficient amounts of physical activity.   
  www.cdc.gov/physicalactivity/everyone/getactive/index.html
• Try not to stay seated for more than 30 minutes at a time.
• Walk around during your lunch break.
• Use the stairs at work or at the mall.  
• Park farthest away from the entrance at stores and businesses.
• Take up a sport or fun activity.
• Join a gym and get a routine of attending.
• Get a workout partner, so you can encourage each other.
• Advocate for physical activity policies at schools.
• Employers should provide a work site wellness program.
• Employers should allow time during the day for physical activity.
• Try to make physical activity part of your everyday routine.
• The city should make it possible and safe to walk and bike on streets and sidewalks.
• Make parks available, accessible, safe and clean in all areas, especially in low-income areas.

www.cdc.gov/physicalactivity/

www.cdc.gov/nccdphp/DNPAO/

Policy Recommendation

• Identify zoning regulations that create a balance between the number of fast-food restaurants and grocery stores in a community, to increase access to healthy foods, especially those within walking distance of neighborhoods.  Incentives may help foster the development of grocery stores in these areas, including smaller, health-food stores (PolicyLink, 2008).

• Require 150min per week of school-based physical education for grades K-5, and 225min for intermediary and high-school students, as recommended by the National Association of Sport and Physical Education.  According to the CDC (2015), children should participate in 60+ minutes of physical activity each day, with three of those days including bone-strengthening activities (e.g. jumping rope, basketball, hopscotch), and three days including muscle-strengthening activities (e.g. playing on playground equipment, tug-of-war).  Physical education classes should incorporate activities that children can utilize outside of class, to increase physical activity, and help meet the recommended 60+ minutes of activity each day.  Additionally, providing access to playgrounds after school hours, including supervision immediately following school hours, can encourage physical activity in children, as well as providing funding for extracurricular activities outside of school, especially for low-income families that cannot afford the fees and equipment costs (Guide to Community Preventative Services, 2013).

General Recommendations

• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Review these guidelines on how much physical activity you need a week.   
  www.cdc.gov/physicalactivity/everyone/guidelines/index.html
• Review these examples on how to get sufficient amounts of physical activity.   
  www.cdc.gov/physicalactivity/everyone/getactive/index.html
• Try not to stay seated for more than 30 minutes at a time.
• Walk around during your lunch break.
• Use the stairs at work or at the mall.  
• Park farthest away from the entrance at stores and businesses.
• Take up a sport or fun activity.
• Join a gym and get a routine of attending.
• Get a workout partner, so you can encourage each other.
• Advocate for physical activity policies at schools.
• Employers should provide a work site wellness program.
• Employers should allow time during the day for physical activity.
• Try to make physical activity part of your everyday routine.
• The city should make it possible and safe to walk and bike on streets and sidewalks.
• Make parks available, accessible, safe and clean in all areas, especially in low-income areas.

www.cdc.gov/physicalactivity/

www.cdc.gov/nccdphp/DNPAO/

General Recommendations

• If feeling depressed, visit your doctor for a consultation.
• Know these symptoms of mental illness.    
  www.mayoclinic.org/diseases-conditions/mental-illness/basics/symptoms/con-20033813
• Pay close attention to warning signs of depression.
• If diagnosed with depression, take your medication consistently and correctly.
• Try to avoid drugs and alcohol that may make your depression worse. 
• Try these mental health-screening tools, but these should not replace a doctor’s visit.   
  www.mentalhealthamerica.net/mental-health-screening-tools
• Review these general health resources on mental health.   www.cdc.gov/mentalhealth/gen-resources.htm
• Find behavioral health treatment services in your area.   findtreatment.samhsa.gov/

www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm

General Recommendations

• Apply for SNAP (Supplemental Nutrition Assistance Program) benefits.   
  www.fns.usda.gov/snap/snap-application-and-local-office-locators
• Get unemployment insurance.
• Check out these socioenvironmental maps of poverty in the US.   www.cdc.gov/dhdsp/maps/sd_poverty.htm
• Get involved in the ‘Caring Across Generations’ movement.   www.caringacross.org/action-center/
• Help homeless families by volunteering at a local shelter.                                       
  • www.meltrotter.org/volunteer_1
  • www.safehavenministries.org/volunteer
  • www.familypromisegr.org/volunteer
  • www.kidsfoodbasket.org/volunteer/volunteer

General Recommendations

• African American men (and other high-risk men) should discuss prostate cancer screening with their doctor around 40-45 years of age.
• After discussing with their doctor, men who want to be screened should be tested using the PSA (prostate-specific antigen) blood test.  The DRE (digital rectal exam) can also be used for screening.
• Consult your doctor about your risk of prostate cancer. 
• Know your family history of prostate cancer.
• Consume healthy foods such as fruits, vegetables, lean meat, fish, dry peas or beans, and whole grains.
• Eat more fat from plants than from animals.
• Eat fish such as tuna, salmon and herring.
• Reduce the amount of dairy products you consume each day.
• Cook with olive oil instead of butter.
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Refrain from smoking or using tobacco.

www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer-prevention/art-20045641

www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-acs-recommendations

www.cdc.gov/cancer/prostate/

General Recommendations

• Check out these affordable housing options in Grand Rapids, Michigan.   www.dwellingplacegr.org/affordable-housing
• Visit the Grand Rapids Housing Commission that provides assistance to low-income residents.   www.grhousing.org/
• Get resources from the Fair Housing Center of West Michigan.   www.fhcwm.org/whatisfairhousing
• Review these federal assistance-housing programs.
  • Housing support services    www.dwellingplacegr.org/support-services
  • Rent assistance programs    www.rentassistance.us/ci/mi-grand_rapids
  • Learn about the “Housing First” initiative.   www.housingfirstinitiative.org/

General Recommendations

• Refrain from smoking or tobacco use.
• Know and monitor your blood pressure and cholesterol levels.  A doctor can check both. 
  www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Family-History-and-Heart-Disease-Stroke_UCM_442849_Article.jsp
• Know the signs and symptoms of a heart attack.   www.cdc.gov/heartdisease/signs_symptoms.htm
• Know the signs and symptoms of a stroke.   www.cdc.gov/stroke/signs_symptoms.htm
• Maintain a healthy weight. Consult your doctor about a healthy weight for you.
• Consume healthy foods and beverages such as fruits, vegetables, lean meat, fish, dry peas or beans, whole grains, and low-fat skim milk and cheese.
• Get 150 minutes of moderate physical activity per week (e.g., brisk walking).
• Work all of your major muscle groups 2 days per week (legs, hips, back, abdomen, chest, shoulders, arms).
• Get regular health screenings.
• Reduce your stress levels.
• Take medication prescribed by your doctor for hypertension, cholesterol or diabetes.
• Get enough sleep.   www.cdc.gov/sleep/about_sleep/how_much_sleep.htm

www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Assess-Your-High-Blood-Pressure-Related-Risks_UCM_301829_Article.jsp

www.cdc.gov/dhdsp/

General Recommendations

• Practice abstinence from sex.
• Limit your number of sex partners.       
• Use a new condom correctly every time you have sex.   www.cdc.gov/condomeffectiveness/brief.html
• Know your partner’s HIV and STD status.
• Mentor teens about safe sex and the risks of sex.
• Schools should offer culturally appropriate programs on sex education.
• Parents should help their teens avoid risky situations.
• Review these parent and guardian resources on teen pregnancy.   www.cdc.gov/teenpregnancy/parents.htm
• Use these strategies to talk to your teens about sex.   
  www.webmd.com/parenting/talking-to-kids-teens-about-sex-directory
• Get counseling, testing and treatment in Kent County, Michigan.   www.accesskent.com/Health/PersonalHealth/

www.cdc.gov/teenpregnancy/

Policy Recommendations

• Increasing the excise tax on alcohol has been associated with a reduction in alcohol-related risky behavior, which has been found to reduce the contraction of certain STIs, including chlamydia and gonorrhea (Staras, Livingston, Christou, Jernigan, & Wagenaar, 2014).

• Enact a policy that provides structural-level condom distribution intervention, such as having free condoms available in the nurse’s office in public schools, to increase access to condoms, ensure proper understanding of use, and to enhance sexual education.  Providing interaction with the student is more effective than providing condoms alone, but both methods were found to increase condom use, and decrease contraction of STIs (Charania et al., 2011).  Other interventions include: condom informational booths, condom vending machines in restrooms, and group meetings to ensure access and proper use of condoms.

• Incorporate a health center into all middle- and high-schools, proving sexual health education, information, and counseling, as well as providing condoms, and instruction on proper use, to students.

www.advocatesforyouth.org/publications/449-school-condom-availability

Program Recommendations

• Provide comprehensive, age-appropriate sexual education in public schools which includes a heirarchy for risk behaviour, including abstinence as the best protection from STIs, as well as safe sex instruction and education (Guide to Community Preventive Services, 2009).

See: www.advocatesforyouth.org/publications/2094 for 36sexual education programs (school-, community-, and clinic-based) that have been proven to be effective.

Also see: www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/db/tpp-searchable.htm for an additional list of evidence-based sexual health and education programs. 

www.thecommunityguide.org/hiv/riskreduction.html

General Recommendations

• Stop or reduce your smoking habits.
• Stop or reduce your smokeless tobacco habits.
• Policymakers can make all common areas in the city smoke free.
• Know the health effects of smoking or secondhand smoke.  www.cdc.gov/tobacco/basic_information/health_effects/index.htm
• Providers can provide incentives to employees to quit using tobacco.
• Policymakers can increase the sales tax on tobacco products.
• Health insurance companies can decrease out of pocket costs for tobacco cessation programs.
• Review this guide on how to quit smoking.   www.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/
• Read the warning labels on cigarette cartons.   

www.cdc.gov/tobacco/

Policy Recommendations

• Expand HUD's mandatory radon testing for multi-dwelling family units to all rental units, and encourage low-cost radon testing for all housing that is not rental property. Home test kits for radon gas are available at the Kent County Health Department, Environmental health Division, 700 Fuller N.E. Cost: $5.00. Call (616) 632-6900 for more information.

• Strictly enforce the current public smoking ban, and restrict tobacco smoking from within 25ft of all non-residential building entrances.  Citation profits could help provide for a tobacco cessation program such as the Michigan Tobacco Quitline (michigan.quitlogix.org/).

• Increase tobacco excise taxes to reduce youth and adult tobacco use.  Increased revenue from tobacco sales can help fund and support tobacco education and cessation programs.

Program Recommendation

• Tobacco cessation program funding

General Recommendations

• File for unemployment benefits.  Also, see if you qualify for unemployment benefits.  www.michigan.gov/documents/uia_ClmUnempBenFactSheet36English_76381_7.pdf
• Check out the Hope Network.   hopenetwork.org/services/support-services/workforce-development/
• To search for jobs in Michigan, check out Michigan Works!   www.michiganworks.org/job-seekers/
• Learn new skills while you are unemployed.
• Increase incentives for people to find paid work.

General Recommendations

• Get health insurance.
• Get annual physicals.
• Know your family history of illness or disease.
• Know your health status and any illnesses.
• Take any prescribed medication as instructed by your doctor.
• Don’t ignore any health problems or concerns.
• Review different health insurance plans with a trained professional to learn the best one for you.
• Get a ride to your doctor.   www.lakeshoreridelink.org/
• Check out these health care and insurance companies.
  • Mercy Health   www.mercyhealthsaintmarys.com/welcometosaintmarys
  • Cherry Health   www.cherryhealth.org/about/
  • Spectrum Health   www.spectrumhealth.org/
  • Heartland-ManorCare   
    www.heartland-manorcare.com/find-a-location/locations/heartland-health-care-center-grand-rapids/
  • Health Intervention Services   www.hisgr.org/
  • Community Home Health Care Services   www.visitingnurse.com/mi/