Health Data Profile

Profile Summary & Overview

This is the Data Profile for Kent County, Michigan. The indicators are color coded to show the health status for Kent County or the Grand Rapids-Wyoming (GR-WY) metropolitan area compared to Michigan and the United States. This specification between Kent County (or the GR-WY area) is noted above each indicator. Rate years and data sources can be viewed by clicking the (i) icon below each rate. To navigate through this Data Profile, click the tabs above (Summary, Health Outcomes, Health Behaviors, etc.). The table on the right provides the coding logic, while the rate comparisons are not statistically significant. Click any indicator to view its data.

Health Outcomes


Kent County or Grand Rapids-Wyoming Area Rate
Michigan Rate
United States Rate

To view the rate years or data sources, move your cursor over the (i) icon below each number.
Arthritis

Percentage of adults who have been told by their doctor that they have arthritis.

GR-WY Area Only

Asthma

Percentage of adults who have ever been told that they have asthma.

GR-WY Area Only

Breast Cancer Deaths

Rate of women per 100,000 who died of breast cancer.


22.7


20


19.4

Child Mortality

Rate of deaths among children under age 18 per 100,000.


50


50


50

Chlamydia

Rate of people per 100,000 who tested positive for chlamydia.


508.6


448.9


481.3

Depression

Percentage of people who were ever told that they have any form of depression.

GR-WY Area Only

Diabetes

Percentage of people who ever been told by a doctor that they have diabetes.

GR-WY Area Only

Disability

Percentage of adults who have serious difficulty walking or climbing stairs.

GR-WY Area Only

Gonorrhea

Rate of people per 100,000 who tested positive for gonorrhea.

GR-WY Area Only

Heart Disease Deaths

Rate of people per 100,000 who died of heart disease.


184.9


206


167

High Blood Pressure

Percentage of adults who have ever been told by their doctor that they have high blood pressure.

GR-WY Area Only

High Cholesterol

Percentage of adults who have had their blood cholesterol checked, and were told by their doctor that it was high.

GR-WY Area Only

HIV

Rate of people per 100,000 who ever tested positive for HIV.


188.6


195.8


378

Infant Mortality

Rate of live births per 1,000 who died before they turned one year old.


6.7


6.8


5.4

Injury Mortality

Rate of people per 100,000 who died from intentional and unintentional injuries. Deaths included are those with an underlying cause of injury (ICD-10 codes *U01-*U03, V01-Y36, Y85-Y87, Y89).


67


81


70

Lead Poisoning in Children

Percentage of children 0-72 months old (or birth to 5yrs old) with a blood lead level > 5μg/dL.

GR-WY Area Only

Low Birthweight Babies

Percentage of live birth babies who weigh less than 2,500 grams (or 5.5 pounds).

GR-WY Area Only

Lung Cancer Deaths

Rate of people per 100,000 who died of lung cancer.


32.6


38


34.8

Obesity

Percentage of people who were classified as having a Body Mass Index between 30 and 99.8.

GR-WY Area Only

Opioid Overdose Mortality

Rate of deaths involving an opioid overdose per 100,000 people using underlying cause of death codes: X40-X44, X60-X64, X85, and Y10-Y14.


12.9


22.5


21.4

Overweight

Percentage of people who were classified as having a Body Mass Index between 25 and 29.9.

GR-WY Area Only

Poor Mental Health Days

Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days.

GR-WY Area Only

Prostate Cancer Deaths

Rate of men per 100,000 who died of prostate cancer.


14.7


19.8


18.4

Stroke Deaths

Rate of people per 100,000 who died of a stroke.


32.8


44.8


38.6

Syphilis

Rate of people per 100,000 who tested positive for syphilis.


21.6


20.2


40.8

Teenage Births

Rate of births per 1,000 females aged 15-19.


19


14


15

Health Behaviors


Kent County or Grand Rapids-Wyoming Area Rate
Michigan Rate
United States Rate

To view the rate years or data sources, move your cursor over the (i) icon below each number.
Binge Drinking

Percentage of males having 5 or more drinks on one occasion, or females having 4 or more drinks on one occasion.

GR-WY Area Only

Breastfed Infants

Percentage of infants who were ever breastfed.

GR-WY Area Only

Dental Care

Percentage of adults who visited a dentist or dental clinic within the past year for any reason.

GR-WY Area Only

Excessive Drinking

Percentage of adults that report either binge drinking, defined as consuming more than 4 alcoholic beverages (for women) or 5 alcoholic beverages (for men) on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than 1 drink (for women) or more than 2 drinks (for men) per day on average.
22%

GR-WY Area Only

Fruit Consumption

Percentage of people who consumed fruit one or more times per day.


61.7


59.9


60.2

Heavy Drinking

Percentage of adult men having more than 14 drinks per week or adult women having more than 7 drinks per week.

GR-WY Area Only

Immunized Children

Percentage of children (from 19-36 months of age) who completed their recommended immunization series (4:3:1:3:3:1:4). Click on resources, web links, national, then scroll down to “immunized children” for more information about this immunization series.

GR-WY Area Only

Mammography Use

Percentage of women aged 40+ who have had a mammogram for breast cancer screening within the past two years.

GR-WY Area Only

Physical Activity

Percentage of people who participated in 150 minutes or more of aerobic physical activity per week.

GR-WY Area Only

Physical Inactivity

Percentage of adults (aged 20 and over) who reported no leisure-time physical activity.

GR-WY Area Only

PSA Test

Percentage of men aged 40+ who have had a PSA (prostate specific antigen) test for prostate cancer screening within the past two years.

GR-WY Area Only

Tobacco Use

Percentage of adults who are current smokers.

GR-WY Area Only

Vegetable Consumption

Percentage of people who consumed vegetables one or more times per day.


77.7


79.3


79.6

Social Determinants of Health


Kent County or Grand Rapids-Wyoming Area Rate
Michigan Rate
United States Rate

To view the rate years or data sources, move your cursor over the (i) icon below each number.

Economic

Children in Poverty

Percentage of children under age 18 living in poverty.

GR-WY Area Only

Income Level

Percentage of households that earn $50,000 or more per year.

GR-WY Area Only

No High School Diploma

Percentage of people with no high school diploma.

GR-WY Area Only

Poverty

Percentage of people living in poverty.

GR-WY Area Only

Unemployment

Percentage of people who are currently unemployed.

GR-WY Area Only

Health Care

Health Care Costs

Estimated percentage of the population who could not see a doctor because of cost in the past year.

GR-WY Area Only

Health Care Coverage

Percentage of people who had any kind of health care coverage.

GR-WY Area Only

Uninsured

Estimated percentage of people who had no health insurance coverage.

GR-WY Area Only

Uninsured Children

Percentage of people under age 19 with no health insurance.

GR-WY Area Only

Home

Child in Single-Parent Households

Percentage of all children in family households that live in a household headed by a single parent (male or female head of household with no spouse present).

GR-WY Area Only

Homeownership

Percentage of adults who own their own home.

GR-WY Area Only

Severe Housing Problems

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.

GR-WY Area Only

Physical Environment

Access to Exercise Opportunities

Percentage of the population with adequate access to locations for physical activity. Adequate access is defined as individuals who: reside in a census block within a half mile of a park, or in urban areas: reside within one mile of a recreational facility, or in rural areas: reside within three miles of a recreational facility.
91%

GR-WY Area Only

Access to Healthy Foods

Proportion of the population that is low income and lives close to a grocery store. Living close to a grocery store is defined differently in rural and nonrural areas; in rural areas, it means living less than 10 miles from a grocery store whereas in nonrural areas, it means less than 1 mile. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size.

GR-WY Area Only

Air Pollution

The average daily measure of fine particulate matter in micrograms per cubic meter (PM2.5) in a county.


8.8


7.4


8.6

Exposure to Violent Crimes

Rate of people per 100,000 that experience a violent crime. Violent crime is defined as offenses that involve face-to-face confrontation between the victim and the perpetrator, including homicide, forcible rape, robbery, and aggravated assault.


373


443


386

Social Environment

Child Abuse/Neglect

Rate of children (under 18) per 1,000 in a given fiscal year where alleged abuse or neglect is confirmed after an investigation.


10.9


12.1


8

Civic Engagement

Percentage of eligible adults who voted in the 2020 Presidential election.

GR-WY Area Only

Disparities


Below are rate comparisons by race/ethnicity in Kent County, Michigan. Not every rate difference is a significant disparity. To view the rate years or data sources, move your cursor over the (i) icon by each graph title. You can quickly view a specific indicator by using the “Jump to” box above.

Asthma

Percentage of adults who have ever been told that they have asthma.

Race/Ethnicity

  • Black
  • White
  • 19%
  • 14.1%

Binge Drinking

Percentage of males having 5 or more drinks on one occasion, or females having 4 or more drinks on one occasion.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 14.5%
  • 19.2%
  • 26.6%

Breast Cancer Deaths

Rate of women per 100,000 who died of breast cancer.

Race/Ethnicity

  • Black
  • White
  • 23
  • 16.1

Child Mortality

Rate of deaths among children under age 18 per 100,000.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 110
  • 40
  • 50

Children in Poverty

Percentage of children under age 18 living in poverty.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 37%
  • 6%
  • 29%
  • 8%

Dental Care

Adults who visited a dentist or dental clinic within the past year for any reason.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 62%
  • 75.1%
  • 71.9%

Depression

Percentage of people who were ever told that they have any form of depression.

Race/Ethnicity

  • Black
  • White
  • 14.8%
  • 19%

Diabetes

Percentage of people who ever been told by a doctor that they have diabetes.

Race/Ethnicity

  • Black
  • White
  • 15.1%
  • 10%

Disability

Among all adults, the proportion who reported having serious difficulty hearing, visual impairment, difficulty concentrating, remembering, or making decisions, difficulty walking or climbing stairs, difficulty dressing or bathing, or difficulty doing errands alone.

Race/Ethnicity

  • Black
  • White
  • 25.6%
  • 23.3%

Health Care Costs

Estimated percentage of the population who could not see a doctor because of cost in the past year.

Race/Ethnicity

  • Black
  • White
  • 10.2%
  • 8.8%

Health Care Coverage

Percentage of people who had any kind of health care coverage.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 88.2%
  • 94%
  • 76.4%

Heart Disease Deaths

Rate of people per 100,000 who died of heart disease.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 541.3
  • 316.9
  • 193.8
  • 107.9

High Blood Pressure

Percentage of adults who have ever been told by their doctor that they have high blood pressure.

Race/Ethnicity

  • Black
  • White
  • 34.4%
  • 32.4%

High Cholesterol

Percentage of adults who have had their blood cholesterol checked, and were told by their doctor that it was high.

Race/Ethnicity

  • Black
  • White
  • 26.3%
  • 30%

HIV

Rate of people per 100,000 who ever tested positive for HIV.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 725.4
  • 109.2
  • 302.5
  • 99.9

Infant Mortality

Rate of live births per 1,000 who died before they turned one year old.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 13.8
  • 4.8
  • 8.5

Lead Poisoning in Children

Percentage of children 0-72 months old (or birth to 5yrs old) with a blood lead level > 5μg/dL.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 10.9%
  • 5.1%
  • 6.8%
  • 4.8%

Low Birthweight Babies

Percentage of live birth babies who weigh less than 2,500 grams (or 5.5 pounds).

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 15%
  • 7%
  • 8%
  • 9%

Lung Cancer Deaths

Rate of people per 100,000 who died of lung cancer.

Race/Ethnicity

  • Black
  • White
  • 46.3
  • 31.3

Obesity

Percentage of people who were classified as having a Body Mass Index between 30 and 99.8.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 41.6%
  • 28.5%
  • 30.1%

Overweight

Percentage of people who were classified as having a Body Mass Index between 25 and 29.9.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 35.3%
  • 36.9%
  • 45.1%

Physical Activity

Percentage of people who participated in 150 minutes or more of aerobic physical activity per week.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 75.6%
  • 83.2%
  • 78.2%

Poor Mental Health Days

Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days.

Race/Ethnicity

  • Black
  • White
  • 12.1%
  • 13%

Poverty

Percentage of people living in poverty.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 25.9%
  • 6.5%
  • 18.9%
  • 6%

Prostate Cancer Deaths

Rate of men per 100,000 who died of prostate cancer.

Race/Ethnicity

  • Black
  • White
  • 44.4
  • 16.5

Stroke Deaths

Rate of people per 100,000 who died of a stroke.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 50.5
  • 30.1
  • 36.7

Teenage Births

Rate of births per 1,000 females aged 15-19.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • 32.3
  • 7.7
  • 27.3

Tobacco Use

Percentage of adults who are current smokers.

Race/Ethnicity

  • Black
  • White
  • 9.2%
  • 13.1%

Unemployment

Percentage of people who are currently unemployed.

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 8.4%
  • 3.7%
  • 7.5%
  • 9.6%

Uninsured

Estimated percentage of people who had no health insurance coverage

Race/Ethnicity

  • Black
  • White
  • Hispanic
  • Asian
  • 6.6%
  • 3.7%
  • 11.1%
  • 6.2%

Recommendations


View GRAAHI’s recommendations below. Scroll and click any indicator, or use the “Jump to” box above to choose one. These recommendations can improve you and your region’s health.

Access to Exercise Opportunities
  • 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.

www.cdc.gov/nccdphp/dnpao/index.html

Access to Healthy Foods
Air Pollution
  • 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
  • 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
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/

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
Binge Drinking
  • 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.

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

Program Recommendation

  • Disseminate information regarding the educational information and tools available at Rethinking Drinking.  These toolkits are designed to identify individual consumption of alcohol and provide information regarding the health risks with excessive drinking.  This information can be found at: rethinkingdrinking.niaaa.nih.gov/
Breastfed Infants
Child Abuse/Neglect
  • Be aware of the resources in your community.
    • 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/what-is-child-abuse/
  • 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.
Child in Single-Parent Households
Civic Engagement
Dental Care
Depression
Diabetes
  • 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 neighborhood or community-level diet and physical activity promotion programs, with an emphasis on prevention or control of diabetes (Guide to Community Prevention Services, 2014).
Disability
  • 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

Excessive Drinking
  • 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.

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)
Exposure to Violent Crimes
  • 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’re 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.
Health Care Costs
Health Care Coverage
Heart Disease Deaths

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
High Blood Pressure

www.cdc.gov/bloodpressure/      |      www.nursingtimes.net/the-importance-of-blood-pressure-control/199429.fullarticle

High Cholesterol

www.hopkinsmedicine.org/digestive_weight_loss_center/conditions/high_cholesterol.html    |     www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf

HIV

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.

advocatesforyouth.org

Program Recommendations

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

See: advocatesforyouth.org for sexual 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

Immunized Children

Program Recommendation

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

www.thecommunityguide.org/vaccines/incentiveRewards.html

  • Develop a program that provides an in-home vaccination service for those who 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.thecommunityguide.org/findings/vaccination-programs-home-visits-increase-vaccination-rates

Inadequate Social Support
  • 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.experiencegr.com/events/
  • Visit the social websites in your area for upcoming events.
Infant Mortality
  • 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.

To prevent infant mortality DURING and AFTER PREGNANCY, follow these recommendations:
  • Seek medical care immediately after learning of your pregnancy.
  • 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
  • Practice safe sleep habits. www.youtube.com/watch?v=09kNXxYB_Ko
  • Review “Coping with Crying” to reduce shaken baby syndrome. https://cms-kids.com/families/child_family_info/keeping_your_child_safe/coping_with_crying.html
  • Follow the steps in this link to reduce the risk of SUID (Sudden Unexpected Infant Death) syndrome.  www.cdc.gov/SIDS/index.htm
  • Don’t consume any alcoholic drinks.
  • 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.
  • Refrain from smoking or using tobacco.
  • Don’t use street drugs.
  • Brush your teeth twice and floss daily. See a dentist at least once during your pregnancy.
  • After your child is born, place them in a child safety seat while driving.
  • Try to reduce your stress levels.  For social support, call the programs below:
    • Strong Beginnings – (616) 267-7834
    • Kent County Health Department Maternal Infant Health Program – (616) 632-7058
    • Kent County Healthy Start – (616) 632-7021
  • Report any domestic violence to authorities.
    • National Domestic Violence Hotline – 800-799-7233
    • National Sexual Assault Hotline – 800-656-4673
    • YWCA Counseling Center – (616) 459-4652

www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

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.
Injury Mortality
  • 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. www.redcross.org/local/michigan/take-a-class/cpr-grand-rapids-mi
  • Ensure that the elderly have fall-safe living arrangements.
  • Make sure kids wear life jackets when near water.

www.cdc.gov/injury/

Policy Recommendation

  • Institute stricter enforcement and penalties for seat belt and car-seat-laws to ensure adequate protection during motor vehicle accidents, and to decrease non-compliance.
Lung Cancer Deaths

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. Call (616) 632-6900 for more information.
  • Strictly enforce the current smoking ban, and restrict tobacco smoking from within 25 feet 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.
No High School Diploma
Obesity

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).

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

  • 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).

Program Recommendations

  • Create a family-based support program that emphasizes the amount of screen-time for children (e.g. television, computer, phone), and subsequent lack of physical activity.  There are phone, computer, and television apps available that can restrict the amount of time spent using a certain device, and some cable-providers provide settings that can also limit screen time (Guide to Community Preventative Services, 2014).

www.thecommunityguide.org/obesity/behavioral.html

  • Worksite nutrition and physical activity programs improve education, behavioral and social strategies, and take environmental approaches to increase healthy decisions have been found to be effective, and cost-effective (Guide to Community Preventative Services, 2007).

www.thecommunityguide.org/obesity/workprograms.html

  • Encourage and provide safety measures for active transport or commuting of students to schools.  This may require enforcement of school speed limit zones, proper sidewalk structure, designated drop-off zones, and other safety precautions to ensure adequate safety of school pedestrians.  Additionally, special events such as “Walk to school day,” could be used (Physical Activity Policy Research Network, 2004)
Overweight

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).

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

  • 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).

Program Recommendations

  • Create a family-based support program that emphasizes the amount of screen-time for children (e.g. television, computer, phone), and subsequent lack of physical activity.  There are phone, computer, and television apps available that can restrict the amount of time spent using a certain device, and some cable-providers provide settings that can also limit screen time (Guide to Community Preventative Services, 2014).

www.thecommunityguide.org/obesity/behavioral.html

  • Worksite nutrition and physical activity programs improve education, behavioral and social strategies, and take environmental approaches to increase healthy decisions have been found to be effective, and cost-effective (Guide to Community Preventative Services, 2007).

www.thecommunityguide.org/obesity/workprograms.html

  • Encourage and provide safety measures for active transport or commuting of students to schools.  This may require enforcement of school speed limit zones, proper sidewalk structure, designated drop-off zones, and other safety precautions to ensure adequate safety of school pedestrians.  Additionally, special events such as “Walk to school day,” could be used (Physical Activity Policy Research Network, 2004)
Physical Activity
  • 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).

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

  • 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).

Program Recommendations

  • Create a family-based support program that emphasizes the amount of screen-time for children (e.g. television, computer, phone), and subsequent lack of physical activity.  There are phone, computer, and television apps available that can restrict the amount of time spent using a certain device, and some cable-providers provide settings that can also limit screen time (Guide to Community Preventative Services, 2014).

www.thecommunityguide.org/obesity/behavioral.html

  • Worksite nutrition and physical activity programs improve education, behavioral and social strategies, and take environmental approaches to increase healthy decisions have been found to be effective, and cost-effective (Guide to Community Preventative Services, 2007).

www.thecommunityguide.org/obesity/workprograms.html

  • Encourage and provide safety measures for active transport or commuting of students to schools.  This may require enforcement of school speed limit zones, proper sidewalk structure, designated drop-off zones, and other safety precautions to ensure adequate safety of school pedestrians.  Additionally, special events such as “Walk to school day,” could be used (Physical Activity Policy Research Network, 2004)
Physical Inactivity
  • 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).

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

  • 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).

Program Recommendations

  • Create a family-based support program that emphasizes the amount of screen-time for children (e.g. television, computer, phone), and subsequent lack of physical activity.  There are phone, computer, and television apps available that can restrict the amount of time spent using a certain device, and some cable-providers provide settings that can also limit screen time (Guide to Community Preventative Services, 2014).

www.thecommunityguide.org/obesity/behavioral.html

  • Worksite nutrition and physical activity programs improve education, behavioral and social strategies, and take environmental approaches to increase healthy decisions have been found to be effective, and cost-effective (Guide to Community Preventative Services, 2007).

www.thecommunityguide.org/obesity/workprograms.html

  • Encourage and provide safety measures for active transport or commuting of students to schools.  This may require enforcement of school speed limit zones, proper sidewalk structure, designated drop-off zones, and other safety precautions to ensure adequate safety of school pedestrians.  Additionally, special events such as “Walk to school day,” could be used (Physical Activity Policy Research Network, 2004)
Poor Mental Health Days
Poverty
Prostate Cancer Deaths
  • Black 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/

PSA Test
  • Black 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/

Severe Housing Problems
Stroke Deaths
  • Refrain from smoking or tobacco use.
  • Know and monitor your blood pressure and cholesterol levels.  A doctor can check both.  www.cdc.gov/vitalsigns/cardiovasculardisease/index.html
  • 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 based on your age.  www.cdc.gov/sleep/about_sleep/how_much_sleep.html

www.cdc.gov/dhdsp/

Teenage Births

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 and ensure the proper understanding of using them via 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 instructions on how to properly use condoms. www.advocatesforyouth.org/resources-tools/

Program Recommendations

  • Provide comprehensive, age-appropriate sexual education in public schools which includes a hierarchy for risk behavior, including abstinence as the best protection from STIs, as well as safe sex instruction and education (Guide to Community Preventive Services, 2009).
  • Review: 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.
Tobacco Use
  • 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. Call (616) 632-6900 for more information.
  • Strictly enforce the current smoking ban, and restrict tobacco smoking from within 25 feet 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.
Unemployment
Uninsured

Indicator Code Explanation

The Kent County or Grand Rapids rate is better than Michigan AND the US rates.
The Kent County or Grand Rapids rate is better than Michigan OR the US rate.
The Kent County or Grand Rapids rate is worse than Michigan AND the US rates.
The Kent County or Grand Rapids rate is the same as the MI or US rate.
Survey