Metropolitan Detroit Research Articles

Lifetime alcohol consumption patterns and young-onset breast cancer by subtype among Non-Hispanic Black and White women in the Young Women's Health History Study.

The role of alcohol in young-onset breast cancer (YOBC) is unclear. We examined associations between lifetime alcohol consumption and YOBC in the Young Women's Health History Study, a population-based case-control study of breast cancer among Non-Hispanic Black and White women < 50years of age. Breast cancer cases (n = 1,812) were diagnosed in the Metropolitan Detroit and Los Angeles County SEER registry areas, 2010-2015. Controls (n = 1,381) were identified through area-based sampling and were frequency-matched to cases by age, site, and race. Alcohol consumption and covariates were collected from in-person interviews. Weighted multivariable logistic regression was conducted to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations between alcohol consumption and YOBC overall and by subtype (Luminal A, Luminal B, HER2, or triple negative). Lifetime alcohol consumption was not associated with YOBC overall or with subtypes (all ptrend ≥ 0.13). Similarly, alcohol consumption in adolescence, young and middle adulthood was not associated with YOBC (all ptrend ≥ 0.09). An inverse association with triple-negative YOBC, however, was observed for younger age at alcohol use initiation (< 18years vs. no consumption), aOR (95% CI) = 0.62 (0.42, 0.93). No evidence of statistical interaction by race or household poverty was observed. Our findings suggest alcohol consumption has a different association with YOBC than postmenopausal breast cancer-lifetime consumption was not linked to increased risk and younger age at alcohol use initiation was associated with a decreased risk of triple-negative YOBC. Future studies on alcohol consumption in YOBC subtypes are warranted.

The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients.

Objective: Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of Aspergillus species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center. Design: We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and aspergillus isolated from the lower respiratory tract and to identify predictors of outcomes in this population. Setting: The setting was a single-center hospital system within the metropolitan Detroit region. Results: The prevalence of Aspergillus isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with aspergillus colonization were high but not significantly different (76% vs. 67%, p = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without Aspergillus isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64-4.06, p = 0.43). In patients in whom Aspergillus was isolated, antifungal therapy (p = 0.035, OR 12.3, CI 1.74-252); vasopressors (0.016, OR 10.6, CI 1.75-81.8); and a higher mSOFA score (p = 0.043, OR 1.29 CI 1.03-1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO2 was the only variable associated with in-hospital mortality in patients in whom Aspergillus was isolated (OR 1.07, 95% CI 1.01-1.27). Conclusions: The isolation of Aspergillus from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.

Locating Arab Americans in Greater Detroit: An Overview of MENA Archives in Southeast Michigan

ABSTRACT Southeast Michigan is home to one of the largest, most highly concentrated populations of people of Middle Eastern and North African (MENA) descent in the United States. This case study includes summaries of MENA-related collections at four separate repositories: the Bentley Historical Library at the University of Michigan, the Arab American National Museum, the Dearborn Historical Museum, and Eastern Michigan University Archives. This region not only provides unparalleled archival holdings, but researchers and archivists are actively working with local MENA communities to create future collections. In this study, staff from each of the four profiled institutions have contributed a summary that links collections across institutions and illustrates the importance of visiting two or more sites to fully understand the region's Arab American community. The authors reveal how researchers can find a rich collection of artifacts and photographs, oral histories, personal papers and organizational records, published materials, and government documents all within a half-hour drive of the Detroit Metro Airport. These collections, which are local, national, and international in scope, make metropolitan Detroit a crucial research site for historians, anthropologists, sociologists, and other scholars examining the life and culture of MENA communities across the United States.

Social mobility and perinatal depression in Black women.

Higher socioeconomic position is associated with better birth outcomes and maternal mental health, although this relationship is less consistent for Black women. The literature is limited on the impact of social mobility across the life course on mental health of pregnant women. This study examines the impact of perceived financial status across the life-course on depressive symptoms during pregnancy among Black women. Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among pregnant Black women in metropolitan Detroit, Michigan. Depressive symptoms in the two weeks prior to birth were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Social mobility was determined at three intervals over the life course using self-report of financial status during childhood, adolescence, and current age in pregnancy. 1,410 pregnant women participated, ranging in age from 18 to 45 years old. CES-D scores ranged from 0 to 53 (mean = 15.3) and 26% of the sample reported high depressive symptoms. In each age interval, higher financial status was associated with significant protective effect on depressive symptoms, and the magnitude of the effect increased across the life course. Trajectory analysis demonstrated that both the upward (4.51; 95% CI, 2.43-6.6) and downward (4.04; 95% CI, 2.62-5.46 and 3.09; 95% CI, 1.57-4.62) life-course social mobility groups had increased mean CES-D scores compared to the static social mobility group. This study describes the importance of previous childhood and current financial status effects on mental health in Black pregnant women.

Tocilizumab Associated With Survival in Patients Hospitalized for COVID-19 Acute Respiratory Distress Syndrome and Low Urine Output.

Acute respiratory distress syndrome (ARDS) with oliguria is associated with increased mortality. Interleukin-6 (IL-6) plays an integral role in the pathophysiology of both disease processes. Patients who experience severe COVID-19 have demonstrated higher IL-6 levels compared to baseline, and use of tocilizumab has demonstrated efficacy in such cohorts. We set out to investigate the relationship between tocilizumab use, COVID-19 ARDS, low urine output, and mortality. Retrospective cohort review of adult patients aged ≥ 18 years with COVID-19 and moderate or severe ARDS, admitted to the intensive care unit (ICU) of a tertiary referral center in metropolitan Detroit. Patients were analyzed based on presence of oliguria (defined as ≤ 0.7 mL/kg/h) on the day of intubation and exposure to tocilizumab while inpatient. The primary outcome was inpatient mortality. One hundred and twenty-eight patients were analyzed, 103 (80%) with low urine output, of whom 30 (29%) received tocilizumab. In patients with low urine output, risk factors associated with mortality on univariate analysis included Black race (P = .028), lower static compliance (P = .015), and tocilizumab administration (P = .002). Tocilizumab (odds ratio 0.245, 95% confidence interval 0.079-0.764, P = .015) was the only risk factor independently associated with survival on multivariate logistic regression analysis. In this retrospective cohort review of patients hospitalized with COVID-19 and moderate or severe ARDS, tocilizumab administration was independently associated with survival in patients with low urine output ≤ 0.7 mL/kg/h on the day of intubation. Prospective studies are needed to investigate the impact of urine output on efficacy of interleukin-targeted therapies in the management of ARDS.

Sleep health and quality of life in African American cancer survivors: The Detroit ROCS Cohort.

10556 Background: Sleep disturbances are particularly prevalent among cancer survivors, likely attributed in part to anxiety over prognosis, treatment, and associated financial concerns. We know little about prevalence, patterns and predictors of poor sleep health in African American (AA) cancer survivors. Sleep problems may contribute in part to the observed disparities in outcomes in this high-risk population and represents a modifiable target to improve quality of life and longer-term health problems. Methods: The Detroit Research on Cancer Survivors (ROCS) study is a large cohort of AA cancer survivors diagnosed with female breast, prostate, colorectal, endometrial, lung or any other early onset cancer on or after 01/01/2013 in Metropolitan Detroit. We have enrolled 5,073 survivors into the study, each completing a baseline survey with annual follow-up to update medical history, health related quality of life (QoL), and other prognostic factors. In 2021, a supplemental sleep survey was administered to all eligible survivors. The current investigation analyzes sleep, QoL (measured using the Functional Assessment of Cancer Therapy - General (FACT-G) survey), and relevant health behavior data from 716 survivors who completed the sleep survey. Sleep health was measured using the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Block regression was used to estimate the contribution of clustered factors to QoL. Five blocks were evaluated: sleep health, demographics, cancer characteristics, comorbidities, and health behaviors. Results: Nearly 60% of AA cancer survivors in the study reported symptoms indicative of poor sleep quality (PSQI score 6-21) with 17% reporting excessive daytime sleepiness (ESS score 11-24) and 11% reporting moderate to severe insomnia (ISI score ≥ 15). Sleep disturbances and poor quality of sleep were associated with clinically meaningful declines in QoL, where survivors with ISI scores in the clinical range reported adjusted FACT-G scores 19 points lower than those with ISI score below the clinical range (95% CI -14.7, -22.6). Sleep health accounted for the largest proportion of variability in FACT-G scores (R2= 0.28) and accounted for an additional 19% of the variance over and above the other 4 blocks. Finally, AA survivors reporting regular physical activity also reported better sleep quality in all 3 sleep scales (p &lt; 0.001). Conclusions: A substantial proportion of AA cancer survivors reported poor sleep quality which impacted their QoL. Understanding the determinants of sleep health in this population will lead to the development of interventions aimed at improving quality of life and downstream health consequences in AA cancer survivors.

Inverse Modeling of Formaldehyde Emissions and Assessment of Associated Cumulative Ambient Air Exposures at Fine Scale

Among air toxics, formaldehyde (HCHO) is an important contributor to urban cancer risk. Emissions of HCHO in the United States are systematically under-reported and may enhance atmospheric ozone and particulate matter, intensifying their impacts on human health. During the 2021 Michigan-Ontario Ozone Source Experiment (MOOSE), mobile real-time (~1 s frequency) measurements of ozone, nitrogen oxides, and organic compounds were conducted in an industrialized area in metropolitan Detroit. The measured concentrations were used to infer ground-level and elevated emissions of HCHO, CO, and NO from multiple sources at a fine scale (400 m horizontal resolution) based on the 4D variational data assimilation technique and the MicroFACT air quality model. Cumulative exposure to HCHO from multiple sources of both primary (directly emitted) and secondary (atmospherically formed) HCHO was then simulated assuming emissions inferred from inverse modeling. Model-inferred HCHO emissions from larger industrial facilities were greater than 1 US ton per year while corresponding emission ratios of HCHO to CO in combustion sources were roughly 2 to 5%. Moreover, simulated ambient HCHO concentrations depended significantly on wind direction relative to the largest sources. The model helped to explain the observed HCHO concentration gradient between monitoring stations at Dearborn and River Rouge in 2021.

The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit.

Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit. We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R. ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092). Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.

Quality of life in endometrial cancer survivors by grade of disease.

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with overall incidence increasing, particularly high-grade disease. There is sparse information regarding quality of life (QOL) in EC survivors with a focus on grade of disease. A total of 259 women with EC diagnosed between 2016 and 2020 were identified via the Metropolitan Detroit Cancer Surveillance System and consented to enroll in the Detroit Research on Cancer Survivors cohort study (if African American, n = 138) or completed the baseline interview (if non-Hispanic white, n = 121). Each respondent provided information about their health history, educational attainment, health behaviors, and demographics. The Functional Assessment of Cancer Therapy-General (FACT-G) and Endometrial-specific (FACT-En) were used to assess QOL. Women diagnosed with high-grade (n = 112) and low-grade (n = 147) EC participated in this study. EC survivors with high-grade disease reported significantly lower QOL compared to survivors with low-grade disease (85 vs. 91, respectively, p value = 0.025) as assessed by the FACT-G. This difference was driven by lower physical and functional subscales among women with high-grade disease compared to those with low-grade disease (p value = 0.016 and p = 0.028, respectively). Interestingly, EC-specific QOL measures, as assessed by the FACT-En, did not differ by grade. Grade of disease impacts QOL in EC survivors, as well as socioeconomic, psychological, and physical factors. Most of these factors are amenable to interventions and should be assessed in patients after an EC diagnosis.

A Critical Review from the Perspective of 2 Years Thereafter of the Effectiveness of Revolutionary Changes in a Gastroenterology Division at a Medical School Teaching Hospital due to the Coronavirus Disease-2019 Pandemic: Gastrointestinal Physician Clinical Practice and Emotional Stresses, Gastrointestinal Graduate Medical Education, Gastrointestinal Professional Societies, and Pandemic Control.

Critically review approximately 2 years afterward the effectiveness of revolutionary changes at an academic gastroenterology division from coronavirus disease-2019 (COVID-19) pandemic surge at the metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to>300 infected patients (one-quarter of) in-hospital census in April 2020 and>200 infected patients in April 2021. GI Division, William Beaumont Hospital which had 36 GI clinical faculty who used to perform>23,000 endoscopies annually with a massive plunge in endoscopy volume during the past 2 years; fully accredited GI fellowship since 1973; employs>400 house staff annually since 1995; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. Expert opinion, based on: Hospital GI chief>14years until September 2019; GI fellowship program director, at several hospitals for>20years; author of 320 publications in peer-reviewed GI journals; and committee-member Food-and-Drug-Administration-GI-Advisory Committee for>5years. Original study exempted by Hospital Institutional Review Board (IRB), April 14, 2020. IRB approval is not required for the present study because this opinion is based on previously published data. Advantageous changes: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19. Affiliated medical school changes included: changing "live" to virtual lectures, meetings, and conferences. Initially, virtual meetings usually used telephone conferencing which proved cumbersome until meetings were changed to completely computerized virtual meetings using Microsoft Teams or Google Zoom, which performed superbly. Some clinical electives were canceled for medical students and residents because of the need to prioritize car for COVID-19 infection during the pandemic, and medical students graduated on time despite partly missing electives. Division reorganized by changing "live" GI lectures to virtual lectures; by four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; postponing elective GI endoscopies; and drastically reducing an average number of endoscopies from 100/weekday to a small fraction long-term! GI clinic visits were reduced by half by postponing nonurgent visits, and physical visits were replaced by virtual visits. Economic pandemic impact included a temporary, hospital deficit initially relieved by federal grants and hospital employee terminations. GI program director contacted GI fellows twice weekly to monitor pandemic-induced stress. Applicants for GI fellowship were interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling annual ACGME fellowship survey, ACGME site visits, and national GI conventions changed from physical to virtual. Dubious changes: Temporarily mandated intubation of COVID-19-infected patients for EGD; temporarily exempted GI fellows from endoscopy duties during surge; fired highly respected anesthesiology group employed for 20years during pandemic leading to anesthesiology shortages, and abruptly firing without warning or cause numerous senior respected faculty who greatly contributed to research, academics, and reputation. Profound and pervasive GI divisional changes maximized clinical resources devoted to COVID-19-infected patients and minimized risks of transmitting infection. Academic changes were degraded by massive cost-cutting while offering institutions to about 100 hospital systems and eventually "selling" institutions to Spectrum Health, without faculty input.

Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit.

Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival. We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors. Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018). Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality. Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.

Abstract A019: Evaluating racial disparities in cancer survivorship via the role of area-level socioeconomic disadvantage in metropolitan Detroit

Abstract The role of socioeconomic status and race on cancer survivorship has been identified, however, the role of neighborhood disadvantage and race in cancer survivorship has not been well studied. This analysis aimed to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer survivorship in the racially diverse population of metropolitan Detroit. We calculated overall and cancer-specific survival for 11,367 Non-Hispanic Black (NHB) and 29,481 Non-Hispanic White (NHW) individuals with breast, colorectal, lung, and prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) at the census block group level using data from the Census Bureau’s American Community Survey. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic, clinical, and treatment factors. Among all participants, an increase in ADI quartile was associated with increased overall mortality for all four cancer sites in multivariable models adjusting for race, age at diagnosis, stage, treatment, and Gleason score (prostate only). When stratifying by race, these associations remained among breast (NHW: Hazard Ratio (HR)=1.10, 95% Confidence Interval (CI) 1.05-1.15, p&amp;lt;0.0001; NHB: HR=1.14, 95% CI 1.05-1.23, p&amp;lt;0.0001), prostate (NHW: HR=1.14, 95% CI 1.09-1.20, p&amp;lt;0.0001; NHB: HR=1.08, 95% CI 1.01-1.16, p&amp;lt;0.0001), and lung cancer (NHW: HR=1.05, 95% CI 1.03-1.08, p&amp;lt;0.0001; NHB: HR=1.05, 95% CI 0.99-1.11, p=0.069), while the ADI-mortality association for colorectal cancer cases appears to be restricted only to NHWs (NHW: HR=1.09, 95% CI 1.05-1.14, p&amp;lt;0.0001; NHB: HR=1.05, 95% CI 0.98-1.12, p=0.15). Associations of cancer-specific mortality were like those of overall mortality, with a few exceptions including Hormone Receptor (HmR)+/HER2-specific mortality which was only significant in NHW women (HR=1.09, 95% CI 0.99-1.20, p=0.077), while HmR+/HER2+-specific mortality was consistent for NHW (HR=1.23, 95% CI 1.01-1.49, p=0.037) and NHB women (HR=1.21, 95% CI 0.84-1.75, p=0.31). Adjustment for ADI substantially attenuated the effects of race on overall mortality for all cancer types, except lung cancer, and significantly attenuated the effect of race on overall mortality for overall breast (proportion attenuated=54%, 95% CI 33-92%, p&amp;lt;0.0001), HmR+/HER2- breast (proportion attenuated=45%, 95% CI 19-113%, p&amp;lt;0.0001), and prostate cancer (proportion attenuated=54%, 95% CI 33-96%, p&amp;lt;0.0001); and attenuated the effects of race on cancer-specific survival only for overall breast (proportion attenuated=40%, 95% CI 16% to 87%, p&amp;lt;0.0001) and marginally for HmR+/HER2- breast cancer (proportion attenuated=24%, 95% CI -4% to 78%, p=0.094). Area-level socioeconomic disadvantage is related to the risk of cancer mortality in a racially diverse population and impacts the role of racial differences in cancer mortality. Citation Format: Natalie G. Snider, Theresa Hastert, Mrudula Nair, Madhav KC, Julie Ruterbusch, Ann Schwartz, Ed Peters, Elena Stoffel, Laura Rozek, Kristen Purrington. Evaluating racial disparities in cancer survivorship via the role of area-level socioeconomic disadvantage in metropolitan Detroit [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A019.

Abstract C129: Lifetime cumulative cigarette exposure and young-onset breast cancer risk by subtype in the Young Women’s Health History Study

Abstract Few studies have described the association between lifetime smoking exposures and young-onset breast cancer (YOBC) risk by BC subtypes including the human epidermal growth factor receptor 2 (HER2) subtype. This study explored associations between lifetime cumulative cigarette smoking exposure from both secondhand smoke (SHS) and personal smoking exposures and YOBC risk, overall and by BC subtype. Data are from the Young Women’s Health History Study, a population-based, case-control study of BC in non-Hispanic Black and White women 20-49 years of age. Invasive BC cases were identified in the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) registry areas, 2010-2015 (n=1,812). Controls were identified through area-based sampling and frequency matched to cases by study site, race and age (n=1,381). Lifetime cumulative cigarette exposure (LCCE) was categorized as no personal or SHS exposure, only SHS exposure in childhood, only SHS exposure in adulthood, SHS exposure in childhood &amp; adulthood, and ever personally smoked (with or without SHS exposure). BC subtypes were defined as Luminal A, Luminal B, HER2-type, and triple negative (TN) BC. We conducted multivariable adjusted sample-weighted logistic regression analysis to estimate the association between LCCE and YOBC risk among all participants and then among women who never personally smoked by duration of SHS exposure (&amp;lt;15 and ≥15 years). We also conducted adjusted polytomous logistic regression analyses and the Wald test to assess heterogeneity by BC subtype. Lifetime cumulative SHS exposure only was reported by 42% of participants, and an additional 37% reported personally smoking. In adjusted models, compared to no SHS, LCCE was not significantly associated with overall YOBC risk. Suggestive differences in YOBC risk by BC subtype were observed, however (P heterogeneity=0.04), with a suggestive increased odds of HER2-type BC with ever smoking (adjusted odds ratio [aOR] 1.61; 95% confidence interval [CI] 0.91, 2.86). Among participants who never smoked, duration of childhood SHS exposure was associated with differences in YOBC risk by subtype (P heterogeneity=0.01); childhood SHS exposure of ≥15 years compared to no childhood SHS was associated with a significantly decreased odds of HER2-type BC (aOR 0.31; 95% CI 0.12, 0.83) and a suggestive increased odds of TNBC (aOR 1.43; 95% CI 0.95, 2.16) while childhood SHS exposure of &amp;lt;15 years compared to no childhood SHS was associated with a suggestive decreased odds of Luminal A BC (aOR 0.74; 95% CI 0.54, 1.03); the latter two findings did not reach statistical significance. Our results suggest that LCCE is associated with differences in risk of YOBC by BC subtype where personal cigarette smoking may be associated with an increased risk for HER2 type YOBC while childhood SHS exposure for ≥15 years may be associated with a decreased risk of HER2 type YOBC and an increased risk of TN YOBC. These findings warrant further examination. Citation Format: Ugonna Ihenacho, Ann S. Hamilton, Wendy J. Mack, Anna H. Wu, Jennifer B. Unger, Dorothy R. Pathak, Kelly A. Hirko, Richard T. Houang, Michael F. Press, Kendra L. Schwartz, Lydia R. Marcus, Ellen M. Velie. Lifetime cumulative cigarette exposure and young-onset breast cancer risk by subtype in the Young Women’s Health History Study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C129.

Academic Work as Factory Work: A Former Blue-Collar Worker’s Observations on Class and Caste in the Academy

What was it like to have come of age after the Glorious Thirty (1945-1975), an era Jack Metzger (2016; 2021a) describes as a time when the working-class bettered their lives? I had the misfortune to have worked in several Metropolitan Detroit factories during the period of decline after the Glorious Thirty. During that time, I witnessed what the journalist George Packer (2013) has called ‘the Unwinding,’ the unraveling of the social contract that has left the working class to their own devices to find success and salvation. In keeping with the tradition in working-class studies of sharing lived experienced of class (Linkon, 2021, pp. 20-31; Strangleman, 2005, pp. 137-51), I highlight my multiple working-class lives to show that academic life is increasingly becoming more like blue-collar labor. Through a discussion of the concepts of class and caste, and the uniqueness of working-class culture, I propose that working-class academic crossovers are essentially ghosts trapped in a liminal limbo in an intellectual version of a contemporary factory that is largely devoid of the benefits of working-class culture.

School Choice, Local Discretion, and Stratification: Evidence From Inter-district Open Enrollment in Metro Detroit

School choice policies can, by design or in implementation, give schools and districts discretion over enrollment. In this study, I examine the effect of local discretion over inter-district open enrollment on non-resident enrollment. I use longitudinal data on open enrollment patterns and policies in the metropolitan Detroit area. I find that when districts set more restrictive open enrollment policies, they enroll fewer new non-resident students overall, due to a decrease in new Black, Hispanic, and low-income non-resident students specifically. When districts allow inter-district open enrollment, racial and socioeconomic segregation within those districts do not change, and racial isolation slightly increases. My findings suggest that regulating enrollment policies to reduce discretionary exclusion can increase access to inter-district choice for some low-income and racially minoritized students, but that these kinds of policy changes are unlikely to reduce racial segregation and socioeconomic stratification more broadly.

Perception of Local COVID-19 Transmission and Use of Preventive Behaviors Among Adults with Recent SARS-CoV-2 Infection - Illinois and Michigan, June 1-July 31, 2022.

During the early stages of the COVID-19 pandemic, use of preventive behaviors was associated with perceived risk for contracting SARS-CoV-2 infection (1,2). Over time, perceived risk has declined along with waning COVID-19-related media coverage (3,4). The extent to which communities continue to be aware of local COVID-19 transmission levels and are implementing recommended preventive behaviors is unknown. During June 1-July 31, 2022, health departments in DuPage County, Illinois and metropolitan Detroit, Michigan surveyed a combined total of 4,934 adults who had received a positive test result for SARS-CoV-2 during the preceding 3 weeks. The association between awareness of local COVID-19 transmission and use of preventive behaviors and practices was assessed, both in response to perceived local COVID-19 transmission levels and specifically during the 2 weeks preceding SARS-CoV-2 testing. Both areas had experienced sustained high COVID-19 transmission during the study interval as categorized by CDC COVID-19 transmission levels.* Overall, 702 (14%) respondents perceived local COVID-19 transmission levels as high, 987 (20%) as substantial, 1,902 (39%) as moderate, and 581 (12%) as low; 789 (16%) reported they did not know. Adjusting for geographic area, age, gender identity, and combined race and ethnicity, respondents who perceived local COVID-19 transmission levels as high were more likely to report having made behavioral changes because of the level of COVID-19 transmission in their area, including wearing a mask in public, limiting travel, and avoiding crowded places or events. Continued monitoring of public perceptions of local COVID-19 levels and developing a better understanding of their influence on the use of preventive behaviors can guide COVID-19 communication strategies and policy making during and beyond the pandemic.

Differences in Self-Reported Food Allergy and Food-Associated Anaphylaxis by Race and Ethnicity Among SAPPHIRE Cohort Participants

Although food allergies are considered common, relatively little is known about disparities in food allergy by race in the United States. To evaluate differences in reported food allergy and food-associated anaphylaxis among individuals enrolled in a longitudinal cohort study from metropolitan Detroit, Michigan. Participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE) were asked about food allergies, including the inciting food and associated symptoms. Individuals were considered to have food-associated anaphylaxis if symptoms coincided with established clinical criteria. Logistic regression was used to assess whether race difference persisted after adjusting for and stratifying by potential confounders. African genetic ancestry was individually estimated among African American SAPPHIRE participants to assess whether ancestry was associated with food allergy. Within the SAPPHIRE cohort, African American participants were significantly more likely to report food allergy (26.1% vs 17%; P= 3.47× 10-18) and have food-associated anaphylactic symptoms (12.7% vs 7%; P= 4.65× 10-14) when compared with European American participants. Allergy to seafood accounted for the largest difference (13.1% vs 4.6%; P= 1.38× 10-31). Differences in food allergy by race persisted after adjusting for potential confounders including asthma status. Among African American participants, the proportion of African ancestry was not associated with any outcome evaluated. Compared with European Americans, African Americans appear to be at higher risk for developing food allergy and food-associated anaphylaxis, particularly with regard to seafood allergy. The lack of association with genetic ancestry suggests that socioenvironmental determinants may play a role in these disparities.

Arab- and Muslim-American organisations in metropolitan Detroit: resistance to the travel ban, 2017–19

The ‘travel ban’ or ‘Muslim ban’, issued by the Trump administration in 2017, was upheld by the Supreme Court in 2018 in its third iteration. It was rescinded by President Biden. This article focuses on the mobilisation of Arab and Muslim Americans as minorities facing intentional discrimination. Responses from diasporas in metropolitan Detroit, which emphasise Muslim- and Arab-American community mobilisation, are examined in detail. The ban led to ten responses, including protests, media activism, communications with Congress and legal action. The research agenda incorporates original research on the activity of 12 organisations in metropolitan Detroit. Analysis focuses on interactions between and among Arab Muslims, other Muslims, Arabic-speaking Christians, Japanese Americans, Latinos and women’s organisations. Examining this active minority response to discrimination tells the story anew – looking at groups’ politicisation, alliances among related but distinct Arab-American and Muslim communities, and coalitions across ethnicities. The research contributes to the academic literatures on Muslim and Arab diasporas.

Stakeholder Preferences in Advanced Public Transportation System Planning

Transportation planning in general and planning for intelligent transportation systems (ITS) in particular are notable both for multiple goals and for multiple constituencies. In response to complex policy environments such as this, multicriteria decision analysis often was utilized to assist in the evaluation of alternative investments or policy directions. This approach is extended here to assess stakeholder valuation of broad goals of an ITS planning process, the Suburban Mobility Authority for Regional Transportation (SMART) operational field test in the metropolitan Detroit area Two levels of goals were considered: broad system-wide goals (e.g, energy savings, interagency coordination, congestion reduction) and specific service characteristics, such as advance reservations, scheduling, and reliability. Using a modified Analytical Hierarchy Process, implicit preference weights for transportation planning goals were derived, and inter- and intra-group comparisons were made. Overall, there was less variation between groups in preferences than might be expected, indicating a fair degree of common ground in desired outcomes of transit planning. The ability to provide for the trips that people request, referring both to the accommodation of trips and the match between requested and scheduled times, were important goals across various stakeholder groups. Similarly, the provision of reliable service was generally valued highly. Information provision appears to be a lower priority. Thus, to the extent that automatic scheduling and dispatch assists improved scheduling trip reservation, and routing it is likely to meet stakeholders ‘preferences.The study characterizes the various groups ‘preferences for transit service along a continuum ranging from “expansive “ to “incremental.” The expansive vision seeks to develop new forms of service for transit and paratransit customers better, while under the incremental view, consolidation of and improvements to existing service are a higher priority. The expansive position appears most clearly among citizens ‘groups, social service agencies, and business people. The business community is particularly interested in expansion of the hours of service, presumably to facilitate travel by customers or employees during evenings and weekends. The more incremental view is held by transportation professionals and SMART employees who are aware of the constraints under which they work.

Volunteer science data show degraded water quality disproportionately burdens areas of high poverty

Anthropogenic activity degrades stream water quality, especially in urban areas. Quantified connections between pollution sources, degree of water quality degradation, and the disproportionate impact of degradation on underserved communities are not yet fully explored. Here, the anthropogenic effects on water quality and the heterogeneous distribution of degraded streams were examined in the urban watershed of the Rouge River in metropolitan Detroit, Michigan. We used benthic macroinvertebrate data collected by volunteer scientists and aggregated into a Stream Quality Index (SQI) to define long-term water quality patterns. Spatial dependence of the data was assessed with spatial stream network models incorporating socio-economic and environmental predictors. The best model included poverty as an explanatory variable with a negative relationship with stream quality. SQI predictions under true watershed conditions revealed a 1% decrease in SQI with 1% increase in poverty. This work demonstrated the benefits of volunteer science and spatial modeling methods for urban stream modeling. Our finding of inequitably distributed water quality impairment in urban streams underscores the importance of focused restoration in economically oppressed urban areas.