Michigan Communities Research Articles

Racial and Ethnic Differences in Emotional Reactions to the Flint Water Crisis among Michigan Women in Communities Outside of Flint.

To determine whether Black women in Michigan communities outside of Flint were more likely than women in other racial and ethnic groups to report negative emotional reactions to the Flint Water Crisis, an ongoing public health disaster that has been widely attributed to anti-Black structural racism. Data were from a 2020 survey of Michigan women aged 18-45 in communities outside of Flint (N=888). We used logistic regression models to examine racial and ethnic differences in the odds of negative emotional reactions to the Flint Water Crisis. Compared with Black women, White women had lower odds of feeling scared (odds ratio [OR]=0.58; 95% CI, 0.40-0.84), hopeless (OR=0.53; 95% CI, 0.38-0.74), tired (OR=0.45; 95% CI, 0.32-0.64), and numb (OR=0.52; 95% CI, 0.35-0.75) when thinking about the water crisis. There were no differences between Black and Hispanic women, whereas women of other races or ethnicities had lower odds than Black women of feeling numb (OR=0.32; 95% CI, 0.14-0.72). The Flint Water Crisis was a racialized stressor, with potential implications for mental health inequities among Michigan women who were not directly affected by the crisis.

How forcing community resilience in rural communities harms sustainable development

Community resilience is critical to managing the effects of climate change and in achieving the United Nations (UN) Sustainable Development Goals (SDG). Resilient communities are able to manage stressors and recover from them, such as in instances of energy service outages. Instances like these can lead to communities that feel forced to exhibit individual characteristics of resilience, such as neighbors relying on each other in times of need because history has shown them that they cannot rely on outside institutions for help. Communities may adopt factors of individual psychological resilience in the face of energy service outages because they lack structural support to exhibit community resilience or to pursue resilient energy systems. This lack of access to support and resources is in conflict with principles of procedural justice and energy sovereignty while reinforcing institutional mistrust within affected communities and contributing to social vulnerability. This article contemplates and expounds on the idea of coerced resilience in the face of energy service outages and severe weather within a rural, remote community in Michigan’s Upper Peninsula (UP). The UP is located at the tail end of electricity infrastructure, putting its residents at increased risk of experiencing energy service outages that are further complicated by its isolation and severe winter weather. We examine the idea of coerced resilience, its relation to social vulnerability, and how it conflicts with concepts of energy justice and the UN’s SDG. We further go on to highlight how certain populations and youth can minimize instances of coerced resilience and contribute to sustainable development making it an important consideration to achieve sustainable development goals.

Technologic and Nontechnologic Barriers to Implementing Behavioral Health Homes in Community Mental Health Settings During the COVID-19 Pandemic.

Persons with serious mental illnesses (SMIs) experience disparities in health care and are more likely to die from physical health conditions than the general population. Behavioral health homes are used in public sector mental health programs to deploy collaborative care to improve physical health for those with SMIs. During the COVID-19 pandemic, these programs faced new challenges in delivering care to this vulnerable group. To describe barriers to implementing or sustaining behavioral health homes, experienced by community mental health workers during the COVID-19 pandemic, and the strategies used to address these challenges. In-depth qualitative interviews were conducted among the behavioral health workforce in Maryland and Michigan community mental health programs. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR), and responses related to implementing and sustaining health homes during the pandemic were coded and themes were analyzed by using an inductive approach. Overall, 72 staff members across 21 sites in Maryland and Michigan were interviewed. Implementation barriers/strategies identified occurred across multiple CFIR domains (client, mental health system, physical health system). Interviewees discussed technologic and nontechnologic challenges as well as strategies to address technology issues. Strategies were more frequently discussed by providers when the barrier was viewed at the client level (eg, low technology literacy) versus the broader system (eg, canceled primary care visits). Community mental health staff described barriers beyond technology in caring for individuals with SMIs and physical health conditions. Further research should examine how implementation strategies address both technologic and nontechnologic barriers to collaborative care.

Increasing COVID-19 Immunization Awareness in Rural Communities Through a Multimedia Campaign.

The purpose of this project was to implement a multimedia campaign to increase COVID-19 vaccine awareness and acceptance in rural communities. This project was created and implemented in partnership with a public university in Michigan and targeted to rural Michigan communities. The campaign consisted of digital advertisements and video interviews with nurses from rural areas. Interview questions were developed using knowledge of the health belief model and allowed the nurses to share their COVID-19 stories. Video interviews were published to social media, and digital advertisements were targeted to rural areas via geofencing. A viewer response survey was provided to measure likelihood of behavior change after viewing. The campaign advertisements and videos reached 602 980 people during the implementation period, and 239 surveys were completed. Of the 53 unvaccinated respondents, 87% stated an increased likelihood to vaccinate. This project supports the ability of the clinical nurse specialist to lead a multimedia campaign partnership that can reach thousands of people and increase the likelihood of vaccination. As the popularity of digital media continues to rise, clinical nurse specialists can embrace these channels to disseminate critical health information.

A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival

Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities. We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival. Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders. Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.

A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals.

During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances. Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1). This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.

Examining Community Engagement Research Strategies Used in Flint, Michigan: The Church Challenge.

The ways in which researchers may need to adapt traditional community-based participatory research engagement strategies during ongoing community trauma are understudied. We describe our efforts to engage the Flint, Michigan community in community-based participatory research in the aftermath of the Flint Water Crisis. This manuscript describes 1) recruitment strategies selected before the Flint Water Crisis, 2) engagement lessons learned in the context of the Flint Water Crisis, and 3) barriers and facilitators encountered while engaging African American churches. Researchers collaborated with community partners to engage and recruit a traumatized Flint community into the Church Challenge, a multilevel intervention to reduce chronic disease burden. Recruitment and engagement strategies must be flexible, innovative, and may require nontraditional methods. Flexibility and adaptability are crucial for engaging with a traumatized community. Community-based participatory research work in traumatized communities must acknowledge and respond to community trauma to be successful.

A multivariate analysis of low-dose CT lung cancer screening in a Michigan community hospital network.

10576 Background: Lung cancer is the leading cause of cancer deaths in the United States. The USPSTF recommended screening for lung cancer with low-dose chest computer tomography (LDCT) in 2013. This was based on the National Lung Screening Trial (NLST) which showed a 20% relative reduction in mortality from LDCT compared with chest radiography in high-risk individuals. The major NLST eligibility criteria were age 55-74, a 30 + pack year smoking history and current smoking status or having quit in the last 15 years. The impact of other risk factors on screening results besides inclusion criteria is unknown. We sought to identify other factors for the risk of lung cancer detection in screened individuals. Methods: This was a retrospective cohort study employing a Michigan based McLaren Hospital Network Lung Cancer Screening Program (LCSP) database from 2015-2022. Participant eligibility in screening was the USPSTF criteria except for an age range of 50-80. Analyses were stratified by BMI, smoking pack-years, insurance status, smoking status, sex, other CT findings, pre- vs. during COVID pandemic (before and after January 2020). Multivariate logistic regression analysis was used for odds ratios (OR) with 95% confidence intervals (CI) as estimates of the relative risk of an elevated Lung-RADS category ≥3 (high risk of detecting lung cancer). Results: A total of 2638 subjects, 49.91% females, 50.09% males, mean BMI 29.50 ± 7.17 (SD), pack-years 44.52 ±18.29, Medicaid 6.66%, Medicare 32.01%, Private Insurance 57.62%, Self-pay /unknown 3.71%. Current smoker 65.49%, Former smoker 34.51%, other CT findings 51.99%, pre-COVID 46.08%, during COVID pandemic 53.92%. Lung-RADS category 0 (0.04%), 1 (35.33%), 2, (50.61%), 3 (6.56%), 4a (4.85%), 4b (1.55%), 4x (1.06%). A statistically significant association with a Lung-RADS category ≥3 was found with lower BMI, OR=0.980 (95% CI, 0.969-0.991), p=0.0005, and female gender, OR=1.232 (95% CI, 1.039-1.462), p=0.0166 (Table). Conclusions: In our study cohort a lower-than-average BMI and also female gender were statistically correlated with an elevated Lung-RADS category ≥3. These findings might be incorporated into a risk stratification model, however further larger studies are needed to validate our findings. [Table: see text]

Capacity for Regulation of Energy Intake in Infancy

The capacity for regulation of energy intake (REI) to match energy needs is thought to contribute to differences in weight gain, and preventing excess infant weight gain is a priority. To determine capacity for REI across infancy. For this cohort study, a convenience sample of mother-infant dyads was recruited from the community in Michigan between 2015 and 2019. Inclusion criteria were healthy, full-term infants with weight appropriate for gestational age; biological mothers who were 18 years or older, English speaking, and a legal and custodial guardian; and infant having had consumed 2 oz or more in 1 feeding from an artificial nipple at least once per week. Infants were followed in the home setting with staff support for up to 12 months. Mother-infant dyads participated at infant age 1, 2.5, 5, 7, 10, and 12 months. In the intervention condition, mothers offered a feeding every hour for 6 hours. In the control condition, mothers fed infants as they typically would for 6 hours. Intake was recorded and kilocalories calculated. Capacity for REI was indexed as the difference in intake in kilocalories per kilogram of body weight (intervention minus control condition); a value of 0 indicated perfect REI. Maternal and infant characteristics were obtained by questionnaire, and anthropometry was measured. Using multiple imputation, the intercept and slope for difference in kilocalories per kilogram across the 6 age points were estimated using mixed models accounting for repeated measures within participants. Statistical analyses were conducted between September 2021 and February 2023. The sample included 175 infants (87 [49.71%] female, 88 [50.29%] male; 494 pairs of intervention and control conditions and 4630 feedings). The mean (SD) 12-month weight-for-age z score was 0.1 (0.8). Mean (SD) gestational age as 39.55 (1.05) weeks, and mean (SD) birth weight was 3.43 (0.41) kg. Mean (SD) breastfeeding duration for those who reported stopping by 12 months was 17.83 (12.03) weeks. As designed, the intervention (compared with control) condition included more feedings at shorter intervals. After collapsing the data across age points in a mixed model accounting for repeated measures within participants, the REI estimate at 1 month differed from 0. On average, infants ate 5.21 kcal/kg (95% CI, 2.89-7.54 kcal/kg) more in the frequent feeding intervention condition than in the ad lib feeding control condition. This difference did not significantly change over 12 months of infancy (REI slope = -0.01 kcal/kg per month; 95% CI, -0.02 to 0.03 kcal/kg per month). The study's findings suggested that, on average, when offered more frequent feedings, healthy, full-term infants may overeat. The results provide support for responsive feeding as a strategy for preventing excess infant weight gain.

Industrial Transitions in Michigan: Stakeholder Perspectives on Water Resources Restoration and Community Vibrancy

Surrounded by four of the five Great Lakes, Michigan is characterized by water. Historically, much of the state’s industry was situated along the water, often preventing public access to waterfronts and negatively impacting the quality of water resources. Economic shifts, paired with a growing interest in revitalizing waterfronts, have led many Michigan communities to invest in water-based restoration projects. This paper investigates the experiences and perceptions of key stakeholders in four waterfront towns where water restoration projects have been implemented as communities shift toward recreation and tourism-based economies. Twenty interviews were conducted with key stakeholders to explore the factors that lead to successful implementation of water restoration and in turn, how these projects impact community vibrancy. Results suggest that community vibrancy related to water restoration can be characterized by a series of reinforcing feedback loops between local leadership, access to water resources, socio-economic and environmental opportunities, and relationships with water.

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan.

Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001). Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for theirinequitable impact on local governments' financial solvency and service quality, but also for their negativeconsequences for population health andracial health equity. The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

Outcomes of high-dose oral beta-lactam definitive therapy compared to fluoroquinolone or trimethoprim-sulfamethoxazole oral therapy for bacteremia secondary to a urinary tract infection.

Compare outcomes of patients receiving high-dose oral beta-lactam versus standard oral therapy for Enterobacterales bacteremia from a urinary tract infection (UTI). Retrospective, multicenter, observational cohort. Three Michigan community teaching hospitals. Adult patients admitted between February 1, 2020, and October 1, 2022, with gram-negative bacteremia from a urinary source were evaluated. Patients receiving active empiric intravenous (IV) antibiotics and transitioned to appropriately dosed oral cephalexin, amoxicillin, fluoroquinolone (FQ), or trimethoprim/sulfamethoxazole (TMP/SMX) were included. Patients receiving less than 72 hours of oral therapy, diagnosed with renal abscess, lobar nephronia, or expired during admission were excluded. Standard oral therapy was defined as FQ or TMP/SMX. The primary outcome compared the composite of recurrent bacteremia or mortality within 30 days of therapy between groups. Secondary outcomes compared recurrent UTI, emergency department or hospital readmission, and Clostridioides difficile within 30 days. 194 patients were included (beta-lactam, n = 75 vs standard therapy, n =119). Patients in both groups were treated for a median of 11 days, with 4 days IV and 7 days oral therapy. There was no difference in the primary outcome between groups (beta-lactam 1.3% vs standard therapy 1.7%, OR 1.27 [95% CI 0.11-14.2]). No patients experienced C. difficile in either group (p = 1.0). Infectious disease consultation was independently associated with standard therapy prescribing (OR 4.4 [95% CI 2.24-8.26]). High-dose oral beta-lactams were as safe and effective as oral FQ or TMP/SMX for the treatment of bacteremia from a urinary source. Most patients received 8-10 days of therapy in both groups.

Use Proactive PFAS Source Tracking to Prepare for Future Regs

Water and wastewater utilities that track emerging contaminants in response to upcoming regulations can learn from a Michigan community's forward‐thinking approach.

Implementation science to analyze motivators and barriers to pharmacist‐prescribed contraception in Michigan community pharmacies

AbstractIntroductionA public health initiative in the United States is to lower the country's 45% unintended pregnancy rate. Although pharmacist‐prescribed contraception is beneficial, implementation is low. Enhancing motivators and overcoming barriers could increase implementation.ObjectivesTo quantify the motivating factors and barriers to pharmacist‐prescribed contraception and compare them by interest in implementing contraception prescribing.MethodsThe Theoretical Domains Framework was used to create an investigator‐developed 41‐item survey. Surveys were mailed to all Michigan independent pharmacies and chain pharmacies granting permission. Descriptive and nonparametric analyses were conducted.ResultsSurvey response rate was 11% (N = 147). Pharmacies were independent (39.5%), small independent group (2‐4 stores, 21.8%), large independent group (≥5 stores, 8.8%), national chain (15%), and two grocery store chains (15%). Top motivators to implement this service were to increase scope of practice, patient access to contraception, and pharmacy revenue. Top pharmacist, financial, resource, and safety barriers were contraception knowledge gaps, lack of financial reimbursement, lack of physicians to create a collaborative practice agreement, and increased liability, respectively. Pharmacies wanting to implement this service (n = 85) were early change adopters (P &lt; .001), wanted to implement more direct patient care (P &lt; .001), could create collaborative practice agreements (P &lt; .001), had needed resources (P &lt; .001), and were motivated by competition (P &lt; .001) than pharmacies not wanting to implement this service (n = 61). They also felt their patients would value (P &lt; .001) and use (P &lt; .001) pharmacist‐prescribed contraception. Geographical location, city size, pharmacy type, and prescription volume did not significantly differ between pharmacies wanting to implement or not this service.ConclusionPharmacies wanting to implement pharmacist‐prescribed contraception service had more positive attitudes, and better knowledge, skills, and resources than those not wanting to implement the service. Many implementation barriers existed requiring solutions and advocacy efforts by community pharmacy staff, organizations, and colleges to increase implementation of this service in community pharmacies.

Birth Control Use and Access Including Pharmacist-Prescribed Contraception Services during COVID-19.

The COVID-19 pandemic influenced health care with effects on contraception access emerging. The study objectives were to analyze pandemic impacts on birth control (BC) use and access; and evaluate perceptions of pharmacist-prescribed BC. A 50-item survey was distributed by 31 Michigan community pharmacies to women aged 18-45 over a three-month period. The survey link was also posted on two websites. 147 surveys were analyzed. Respondents were 29 ± 7.9 years old, primarily white (77%) and straight (81%). Fifty-eight percent of respondents used prescription BC, mostly to prevent pregnancy (84%) with oral pills (76%) being the most common formulation. Some BC users (25%) were worried about BC access and 27% had difficulty taking BC regularly. Half of the respondents (50%) would likely use pharmacist-prescribed BC if available, with advantages being more convenient than visiting a doctor's office (71%) and easier access (69%). The major concern about pharmacist-prescribed BC was women not receiving PAP smears and screenings (61%). Respondents reported high confidence (72%) in pharmacist-prescribed BC and believe it would help prevent unintended pregnancies (69%). Some respondents experienced altered BC use and access. Half of the respondents supported pharmacist-prescribed BC. Pharmacist-prescribed BC could help solve pandemic-related access problems.

S943 A New Population With Inflammatory Bowel Disease: Clinical Characteristics of IBD in the Chaldean Population

Introduction: The Chaldean people originate from ancient Babylon, Mesopotamia, known as Iraq in modern times, with a population of approximately 2 million, with 500,000 in the US. It has been anecdotally observed that many Chaldeans suffer from inflammatory bowel disease (IBD), however there is little known about IBD in this population. Cho et al. described four Chaldean families and reported linkage and linkage disequilibrium at chromosome band 1p36 associated with IBD, but no clinical characteristics have been described. The aim of this study is to describe the clinical characteristics of IBD in the Chaldean population. Methods: This was an online survey study sent to the Chaldean community in Michigan via social media platforms. Data collected included demographic information, IBD specific characteristics, family history and barriers to seeking care. Patients who were < 18 years old (y), did not identify as Chaldean or have a diagnosis of IBD were excluded. Results: A total of 74 patients completed the survey (18 excluded due to age, diagnosis uncertainty). Of the 56 completed surveys, 25 (44.6%) with ulcerative colitis (UC), 22 (39.2%) with Crohn’s disease (CD), 9 (16%) with IBD-unspecified (IBD-U). Median age 31y (Range 19-55y), median duration of disease 9y (Range 1-28y) and median age of onset of disease 25y (Range 5-52y). 42 (75%) were females. 12 (21%) have a history of surgery for disease complications. 35% have first degree relative with IBD, 53% have second degree relative with IBD. 66% report delays in seeking medical attention after first symptoms, with minimization of symptoms and embarrassment being the most common reasons. Other reasons included fear, insurance issues and life stressors. (Table) Conclusion: This is the first study to describe clinical characteristics of Chaldean patients with IBD. We found similar rates of UC and CD in our survey population. There are more Chaldean females with IBD, compared to equal rates of males and females with IBD in the general population. In the Chaldean population, we found a significantly higher family history of IBD than the general IBD population which is reported at 8-14%. Despite a strong family history and presumed more exposure to those with IBD, most patients delay seeking medical attention for their symptoms. Further studies are indicated to describe IBD characteristics, clinical course, prognosis and genetic evaluation in the Chaldean population. Table 1. - Title: Demographic and Clinical Characteristics of 56 Chaldean Patients with IBD Variables N=56 Median age, y (Range) 31 (19-55) Median age of diagnosis, y (Range) 25 (5-52) Median duration of disease, y (Range) 9 (1-28) Females, n (%) 42 (75) Delays to seeking care, n (%)1 37 (66) Minimization of symptoms, n (%) 10 (42) Embarrassment, n (%) 6 (25) Fear, n (%) 3 (13) Life stressors, n (%) 3 (13) Insurance barriers, n (%) 2 (8) 1= 24 participants provided reasons for delays to seeking care; y = years

Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis.

Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: −0.09, −0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: −0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.

Restoring relationships: Water heritage, sense of place, and community engagement

Widespread deindustrialization has changed the landscape and the character of many Michigan communities. In response to these often devastating changes, natural resources agencies have invested in restoration projects along Michigan waterfronts to facilitate a shift from an industrial past to new recreation and tourism development. The process of restoration and community rejuvenation is possible because, and depends upon, residents’ deep, often historical, connections with the water, which are in turn rooted in the ways water has been used, enjoyed, and stewarded in their communities, their water heritage. Understanding these nested relationships and the ways residents value the resource is an important component of effective restoration efforts. But conversations about values in natural resources decision-making intended to inform action require a mechanism for values prioritization and an environment of trust. We conducted two community engaged Office of Great Lakes (OGL)-funded studies that focus on Michigan residents’ care for and about the water resources. Both studies used a values ranking activity, a mixed methods approach to studying subjective viewpoints that provides insight into values priorities. In this paper we share the outcomes of both studies to illuminate how values ranking activities can foster stakeholder engagement, facilitate concrete discussions about restoration and natural resources values, and identify patterns in community attitudes about conservation. The analyses provide valuable insight into community dynamics and the potential for restoration success, as well as illuminate the role of sense of place in understanding individual and community values related to water resources.

"Something Fun to Look Forward to": Lessons From Implementing the Prescription for Health Farmers' Market Initiative in Rural Upper Michigan.

Fruit and vegetable (FV) prescription programs are an increasingly popular community-based approach to addressing food insecurity and improving nutrition by connecting local health care and food systems. The Prescription for Health farmers' market FV prescription program was piloted in a rural, low-access low-income Michigan community in 2017. The program enrolled 33 adult participants with chronic disease and provided weekly farmers' market FV vouchers, educational nutrition handouts, and seasonal healthy recipes over 10 weeks. Weight, blood pressure, and the following self-rated variables were assessed pre- and post program: dietary habits, food literacy, physical health, and mental health. While most metrics remained generally unchanged, one of the strongest findings from our data included significant improvement in quality of life. Increased social interaction as a result of the attending the farmers' market was a prominent theme from informal open-ended participant feedback. Given the ongoing public health crisis of loneliness and social isolation, this finding led us to consider the farmers' market as an avenue for creating opportunities for meaningful social connection among participants and farmers. To this end, we discuss health outcomes of the Prescription for Health pilot program, reflect on unique aspects of implementing this program in a rural area, and explore future opportunities for farmers' market prescription programs as an innovative form of nature-based social prescribing.

Non-native Dreissena associated with increased native benthic community abundance with greater lake depth

Although the typical interaction between non-native invasive species and native species is considered to be negative, in some cases, non-native species may facilitate native species. Zebra and quagga mussels (Dreissena spp.) are aggressive invaders in freshwater systems, and they can alter energy flow by diverting nutrients from pelagic to benthic food-webs. In the last two decades, quagga mussels have largely replaced zebra mussels in shallow regions of the Laurentian Great Lakes and colonized deeper waters previously devoid of all dreissenids. Here, we aim to characterize potential positive effects of dreissenids in relation to depth on the benthic community in lakes Michigan and Huron. For this study, we used benthic survey data collected from Lake Michigan in 2015 and Lake Huron in 2017 and annual U.S. EPA Great Lakes National Program Office Long-term Biology Monitoring Program data for both lakes from 1998 to 2019. Benthic species richness and abundance (excluding dreissenids) in both lakes were almost three-fold higher in the nearshore (<70 m) compared to offshore (>70 m) communities. We found that, even though abundance of benthic invertebrates decreased with increased depth, total benthos density and biomass were higher in the presence than in the absence of quagga mussels in both lakes. Moreover, increased quagga mussel density and biomass with depth offset the lower benthos density and biomass at deeper depths, and samples with dreissenids had high densities of oligochaetes in both nearshore and offshore communities. These patterns are consistent with facilitative effects of quagga mussels on both shallow and deep-water benthic communities.