Detroit Residents Research Articles

ORAL HEALTH EQUITY, BELIEFS, PRACTICES, PERCEPTIONS AMONG OLDER DETROIT RESIDENTS

Abstract Oral health disparities are widespread among older and disadvantaged Detroit residents. While preventable, poor oral health is strongly associated with adverse health and social outcomes and increased risk of cognitive impairments. To address limitations in access and knowledge among older Detroit persons, the University of Detroit Mercy Oral Health Equity project is providing free drop-in clinics offering screenings and basic care at multiple local community centers. However, we need person-centered knowledge about the reasons for an individual’s current oral health status and to inform strategies to increase service uptake. We conducted interviews with attendees onsite after their services to learn oral health perceptions, wants, and practices. Findings are reported from a sample, n=62, of predominantly African American, median age 81, female 69%, 50% over two years without a dental visit, and 61% fair to poor self-reported oral health. Analyses used topic, theme, pattern, and critical case content analytic methods. Constructs comprising four key domains were identified: (a) Oral health care exists at the intersection of forces featuring societal, political, historical, local urban place, and economic dimensions beyond individual-level health and behaviors; (b) lifespan pathways into current oral health and care practices, including wishes for future oral health status; (c) barriers and resources to oral health care access and practices; and (d) personal knowledge gaps regarding signs and mechanisms of oral health. Discussion will focus on strategies to reduce disparities and increase utilization, community and person-level knowledge gaps, and training dental students to engage older disadvantaged persons effectively.

242 Assessing Chronic Kidney Disease Knowledge, Beliefs, and Risk Among Detroit Residents

242 Assessing Chronic Kidney Disease Knowledge, Beliefs, and Risk Among Detroit Residents

Assessing Chronic Kidney Disease Knowledge, Beliefs, and Risk among Detroit Residents

ABSTRACT Background In 2020, Detroit residents’ crude kidney disease mortality rate was 1.48 times the state’s rate. Purpose Evaluated Detroit residents’ chronic kidney disease (CKD) knowledge, risk, belief, and preventative practices. Additionally, it examined the association between residents’ CKD knowledge, their sociodemographics, CKD risk and belief. Methods 378 Detroit residents, ages 20 years or older, were recruited from May 2019-August 2021 to complete the Qualtrics survey on their CKD knowledge, beliefs, and risk. Descriptive statistics and multiple linear regression were conducted to meet the study’s purpose. Results Most participants were unaware of dry and itchy skin as a CKD symptom (60%). African Americans (β = −1.5; p = .002) and those with a high school education or less (β = −1.46; p = .038) had lower knowledge scores than White residents and those with higher education. Participants’ knowledge score increased by 0.64 as CKD risk score increased by 1 (β = 0.64; p = .019). Discussion CKD knowledge is low among Detroit residents and associated with race, education, and risk level. Translation to Health Education Practice: African American Detroit residents would benefit from targeted marketing and communication plans that increase their knowledge of CKD prevention. It also depicts key components (e.g., risks factors) that should be communicated in the messages.

Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study.

Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. To examine residents' willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). Trust in the government and education contribute to Detroit residents' wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.

Review of Claire W. Herbert 2021: A Detroit Story: Urban Decline and the Rise of Property Informality. Oakland: University of California Press.

Detroit is the United States’ iconic shrinking city. The birthplace of Motown, it once offered good jobs in the auto industry, a place where people could buy a house and make a home. With its current population at about one third the level of the city’s peak, Detroit residents experience population loss in all dimensions […]

Community's Perception on Ambient Air and Noise Pollution: A Qualitative Study in Southwest Detroit.

Low-income urban communities of color, specifically African American and Hispanic populations living in industrial areas, are disproportionately affected by environmental health hazards, including exposure to air pollution and noise. In Southwest Detroit, a densely populated area with extensive industry and traffic, many residents are chronically exposed to air and noise pollution, contributing to a high prevalence of chronic illnesses such as asthma and cardiovascular disease. To better understand environmental health concerns and perceptions of environmental hazards, we conducted phone interviews with 22 residents in Southwest Detroit. During the interviews, participants were asked to reflect on reports of air and noise pollution based on monitoring inside and outside of their home, how their health might be affected, and to identify their main environmental health concerns. Through qualitative analysis of phone interview notes, we identified truck traffic and inadequate mitigation efforts as concerns for Southwest Detroit residents. Our results suggested that study participants are aware of their disproportionate exposures to air and noise pollution and that while some residents are actively involved in environmental justice efforts, additional structural preventive measures including reduced pollutant emissions, are necessary to preserve public health. This study demonstrates that residents of Southwest Detroit are aware of high levels of both air pollutants and noise and perceive environmental exposures as critical components affecting health, both key aspects of environmental health literacy. This awareness, along with policy change, can facilitate community involvement in evaluating, understanding, and potentially abating air and noise pollution among minority populations.

Deconstructing citizenship and the growth of Detroit's green renaissance

Detroit is in the midst of a contemporary urban renewal project that is being carried out through green gentrification. The displacement of residents is happening through the discursive and political management of the water system, which produces conditions that leave residents with few options for remaining in the city. In this article, I explore how resource management, particularly water and wastewater infrastructure, has been used to degrade the political efficacy of Black Detroit residents. Drawing from ethnographic fieldwork and discourse analysis of news articles and government reports, I argue that in recent years the city of Detroit has developed a wasting economy. This political-economic structure relies on the coupling of deconstructive and constructive processes that promote the withering of citizenship in order to make way for radical racial transformation in access to and control over the city. Keywords: Green gentrification, environmental racism, infrastructural violence, embodied metabolism

Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting.

A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit’s healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.

Rates of Delayed Care Among Detroit Residents During the COVID-19 Pandemic.

Rates of Delayed Care Among Detroit Residents During the COVID-19 Pandemic.

Carceral Structures: Financialized Displacement and Captivity in Detroit

This article develops an analytic of carceral structures that bridge processes of racist inclusion and exclusion. It does so by examining the relocation of a county jail from Detroit's central business district into a hazardous waste corridor. In recent years, county administrators have funded jail expansions using revenues from tax foreclosure surpluses produced by evicting majority-Black Detroit residents. Buildings that disappear Black people within the strictures of mass incarceration are financed by the mass displacement of Black people from their homes. Jails have been central features of Detroit's downtown neighborhood since the 19th century. Surrounding property owners celebrated their late 20th century expansions as a means of supporting districts experiencing the economic fallout of racist population loss. However, when county administrators ran out of funds to complete a jail expansion, developers successfully lobbied to transform the jail site into a campus of a majority-white university. Their plan included rehousing incarcerated people in new jails constructed on the site of unused warehouses adjacent to an incinerator. By attending to Black Detroiters as they navigate dislocations that make incarceration financially possible, this article argues that uneven development is funded by the articulation of racist displacement with racist captivity. In so doing, it offers a model for identifying the expansive structures of carceral institutions as they organize the production of space in the context of racial capitalism.

Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI.

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

Indoor apparent temperature, cognition, and daytime sleepiness among low-income adults in a temperate climate.

The burden of temperature-associated mortality and hospital visits is significant, but temperature's effects on non-emergency health outcomes is less clear. This burden is potentially greater in low-income households unable to afford efficient heating and cooling. We examined short-term associations between indoor temperatures and cognitive function and daytime sleepiness in low-income residents of Detroit, Michigan. Apparent temperature (AT, based on temperature and humidity) was recorded hourly in 34 participant homes between July 2019-March 2020. Between July-October 2019, 18 participants were administered word list immediate (WLL) and delayed (WLD) recall tests (10-point scales) and the Epworth Sleepiness Scale (24-point scale) 2-4 times. We applied longitudinal models with nonlinear distributed lags of temperature up to 7days prior to testing. Indoor temperatures ranged 8-34°C overall and 15-34°C on survey days. We observed a 0.4 (95% CI: 0.0, 0.7) point increase in WLL and 0.4 (95% CI: 0.0, 0.9) point increase in WLD scores per 2°C increase in AT. Results suggested decreasing sleepiness scores with decreasing nighttime AT below 22°C. Low-income Detroit residents experience uncomfortably high and low indoor temperatures. Indoor temperature may influence cognitive function and sleepiness, although we did not observe deleterious effects of higher temperatures.

Racism in medicine: A qualitative study on the impact of discussion among medical students

Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities. Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions. Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001). Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education. Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.

"Treat everybody right": Examining foodways to improve food access

Detroit is regularly assumed to be a “food desert” despite contradicting evidence. With fruits and vegetables available at each of Detroit’s 70 independent, full-line grocery stores, there remains a lack of understanding among media and academics of residents’ perception and preferences for food access. A baseline study was initiated during the summer of 2014 to understand residents’ own perceptions of food access and to assess the socio-cultural foodways utilized by residents. A total of 207 Detroit residents participated in focus groups and interviews to discuss food provisioning. Residents identified a wide range of food access points, from home gardens and fishing to specialty meat markets and big-box stores. However, 60% of residents reported that their primary grocery store was a chain supermarket outside the city limits. Residents highlighted “customer service” and in-store treatment as key factors in choosing where to shop for food. These new findings present contradictions to assumptions about food access in Detroit and similar cities. The findings point to a significant opportunity to leverage geo-ethnographic methods in order to focus on resident perceptions and preferences to improve food access.

Just Out of Reach? Unrestrained Supply, Constrained Demand, and Access to Effective Schools in and Around Detroit

Research concerning family preferences for schooling indicates that they value proximity to home as much as academic quality when choosing schools. However, preferences for proximity likely represent inability to access schools farther away from home, especially for disadvantaged students. I test whether distance and district boundaries constrain access to high-performing and effective schools for Detroit students where families choose between intradistrict, interdistrict, and charter schools, as well as an assigned school. I employ a unique data set that includes enrollment records, addresses, and commute times for Detroit residents regardless of where they attend school. Results show that disadvantaged students have little access to the highest quality schools available, specifically those outside Detroit. However, students attend higher performing schools within Detroit.

Reviving a mortgage market through financial inclusion? Experimental housing governance and alternative home loan programmes in Detroit, Michigan

Since the 2008 financial crisis, the City of Detroit has faced significant housing challenges: the conventional mortgage market in the city has collapsed; numerous residents are precariously housed; and urban ‘blight’ and property abandonment are widespread. This paper offers an empirical focus on one experimental approach to governing these problems: the roll-out of new forms of housing-related loans to low- and moderate-income (LMI) Detroit residents. Under the rubric of financial inclusion, private and public actors have promoted these loan programmes as a way to both improve the housing outcomes of financially excluded residents and reboot the city’s mortgage market. The paper critically analyses these claims through a political economy lens, asking how, why and with what impacts housing-related financial inclusion programmes have been developed in post-crisis Detroit. The paper argues: (1) that these financial inclusion efforts are the products of an existing orientation toward market-based governance mechanisms and have grown out of a broader political project of property market revival; and (2) that in spite of their rhetorical commitments to improving the housing outcomes of LMI residents, many of the new loan programmes are ill-equipped to deliver on these promises in practice, prioritising market revitalisation over the needs of borrowers.

Indoor temperature impacts on cognition and daytime sleepiness in Detroit, Michigan, USA

Introduction: The burden of heat- and cold-associated mortality is significant in the U.S. and globally. However, the impact of temperature on non-emergency health effects is unclear. Prior research suggests associations between extreme indoor temperatures and both cognition and sleep. These associations are potentially stronger in U.S. households facing energy poverty, i.e., living in inadequately weatherized homes and/or lacking resources to afford heating and cooling. We examined short-term associations between indoor temperatures and cognitive function and daytime sleepiness in residents of low-to-moderate income areas of Detroit, Michigan.Methods: A temperature monitor recorded hourly temperatures in the homes of 29 participants from August-October, 2019. Participants were telephoned 2-5 times and administered tests of cognitive function (forward and backward number recall, word list immediate and delayed recall after a 5- minute delay) and questions from the Epworth Sleepiness Scale. Indoor temperatures were available for 15 participants and 40 person-days of cognition and sleepiness tests. Associations were estimated using fixed effects models with nonlinear distributed hourly lags of temperature up to 24 hours prior to testing.Results: Indoor temperatures ranged from 16-35 C. Associations between temperature and sleepiness or forward number and word list recall scores were not significant. Point estimates, however, were consistent with hypothesized deleterious effects at both high and low temperatures. For backwards number recall scores (scale of 0-3 points), at the time of the test (lag 0), for 35 C vs. 25 C, we observed a -0.54 point change in score (p = 0.06), i.e., worse ability to recall, with evidence of additional effects from temperatures at earlier hours.Conclusions: Low-to-moderate income Detroit residents experience high indoor temperatures in the summer and fall, and indoor temperature may influence cognitive function. Further research on indoor temperatures and health is warranted to inform weatherization and utility assistance policies.

Coming to Terms: Applying Contract Theory to the Detroit Water Shutoffs

After the City of Detroit underwent financial takeover and filed the largest municipal bankruptcy in American history in 2013, the city’s emergency manager encouraged mass water shutoffs as a way of making the city’s water utility a more attractive asset for sale. The sale never took place, but the water shutoff, too, became the largest ever in American history, with over 141,000 homes subjected to water disconnections over a period of over six years. The governor of the State of Michigan ordered that the shutoffs be temporarily suspended for the duration of the COVID-19 health emergency in March 2020, and that water be restored to homes that had been disconnected from water services. Human and civil rights activists and health officials have long sought the end of the shutoff campaign based on its disproportionate impact upon Black people, its subjection of people to sub-human living conditions and serious health risks, and its ineffectiveness. Pleading violations of civil and human rights laws, however, has proven unavailing; even condemnations from the United Nations have not sufficed to convince the City of Detroit or the State of Michigan to put a permanent end to the water shutoffs, their lack of success and high human cost notwithstanding. This Essay uses contract theory to clarify the relationships between the people of Detroit and the local, state, and federal governmental bodies exercising jurisdiction over them, and to explain why the shutoffs persist. A racial contract exists amongst Michigan’s white body politic which seeks the exploitation of Black people and resources—including Detroit’s water. Performance of the contract requires the dehumanization and exclusion of Black Detroiters in order to establish and maintain a rent-seeking order in which Black people effectively subsidize the delivery of water and sewage services to white suburbanites who view Black governance and Black proprietorship as a breach of the social order for which they bargained. The City of Detroit has been able to rely on anti-Black narratives and beliefs to create the mirage of a contractual relationship with Detroit residents that Detroiters have breached; in reality, however, Black people lack contractual capacity under the terms of the racial contract, and the City of Detroit and the regional water authority treat Black people’s use of water as an externality resolved through taxation.

Lady Smugglers and Lynx-Eyed Customs Agents: Gender, Morality, and Cross-Border Shopping in Detroit and Windsor

This article examines popular attitudes towards cross-border shopping and smuggling in the Detroit-Windsor border region from 1900 to 1960. Reports of individuals attempting to fool border guards by failing to declare items, wearing multiple layers of clothing, or disguising new purchases as used reveal how shoppers felt entitled to goods and were not deterred by customs regulations. Middle-class families that might otherwise balk at breaking the law saw no problem with lying to border agents. This behaviour was highly gendered: women were characterized as naturally inclined to smuggle, given their love of shopping and inability to comprehend the law. Border guards were selective in their application of the law, and middle-class consumers generally had little to fear when they brought back purchases in excess of customs limits. Smuggling went both ways across the border. During the Second World War, Detroit residents flocked to Windsor to purchase meat and dairy products, while in the postwar period, Canadians more typically frequented American stores. This article offers a new way to think about consumer citizenship and how access to goods was assumed to be a right for people living on both sides of the border.

Heat-Related Illness Is Associated with Lack of Air Conditioning and Pre-Existing Health Problems in Detroit, Michigan, USA: A Community-Based Participatory Co-Analysis of Survey Data

The objective of the study was to investigate, using academic-community epidemiologic co-analysis, the odds of reported heat-related illness for people with (1) central air conditioning (AC) or window unit AC versus no AC, and (2) fair/poor vs. good/excellent reported health. From 2016 to 2017, 101 Detroit residents were surveyed once regarding extreme heat, housing and neighborhood features, and heat-related illness in the prior 5 years. Academic partners selected initial confounders and, after instruction on directed acyclic graphs, community partners proposed alternate directed acyclic graphs with additional confounders. Heat-related illness was regressed on AC type or health and co-selected confounders. The study found that heat-related illness was associated with no-AC (n = 96, odds ratio (OR) = 4.66, 95% confidence interval (CI) = 1.22, 17.72); living ≤5 years in present home (n = 57, OR = 10.39, 95% CI = 1.13, 95.88); and fair/poor vs. good/excellent health (n = 97, OR = 3.15, 95% CI = 1.33, 7.48). Co-analysis suggested multiple built-environment confounders. We conclude that Detroit residents with poorer health and no AC are at greater risk during extreme heat. Academic-community co-analysis using directed acyclic graphs enhances research on community-specific social and health vulnerabilities by identifying key confounders and future research directions for rigorous and impactful research.