Michigan Area Research Articles

Vascular Plant Communities and Flora of the Seven Lakes Nature Preserve in Michigan's Eastern Upper Peninsula

The Seven Lakes Nature Preserve comprises nearly 2,400 hectares of aquatic, wetland, and upland habitats in southeastern Alger and northeastern Schoolcraft counties in the eastern Upper Peninsula of Michigan. The preserve was obtained and protected by the J.A. Woollam Foundation and has undergone several expansions. In an area of Michigan with relatively limited development and few roads, the natural communities of Seven Lakes are highly intact, and many of its habitats have recovered since the historic logging era. Botanical surveys were conducted in 2016, 2017, 2020, 2021, and 2022 with the goals of describing the natural communities and ecosystem processes and of producing a comprehensive floristic inventory. The post-glacial natural history of the region and a description of climate and soils are provided. A floristic quality assessment was performed, yielding a Total Floristic Quality Index of 99.9, a Total Mean C of 4.5 and a Native Mean C of 5.3. Within the upland forests, shrubby and forested wetlands, and open wetlands, eleven plant communities are described following the classification system proposed by the Michigan Natural Features Inventory. The floristic affinities of rare or otherwise noteworthy taxa are discussed, as are potential threats to the ecosystem. Four-hundred ninety-three species and four hybrids were observed during our surveys, 147 species are represented by specimen vouchers and 440 are recorded as photo vouchers on iNaturalist. Sixteen new species records for Alger County are reported.

Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan

BackgroundMaintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare’s impact on participants’ ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers.MethodsWe used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.ResultsIn the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.ConclusionHomecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.

Adolescent-perceived parent-child negative body talk and disordered eating: Evidence for behavior-specific affective mediators.

This study examined the mediating role of general negative affect and body-specific negative affect between the association between negative body talk occurring within the mother-daughter relationship and restrained and disinhibited disordered eating. Adolescent girls (N = 100; Mage = 14.25; 49.5% White) completed self-report measures of general negative affect (depression and anxiety), body-specific negative affect (body dissatisfaction), and perceptions of the frequency that negative body talk occurred in interactions with their mother (initiated by the mother or daughter) as part of a cross-sectional study. While the same set of questionnaires was administered to both mothers and daughters, only the data reported by the daughters were analyzed and included in this study. Data were gathered in the Ann Arbor/Ypsilanti area of Michigan, USA, around the year 2015. Path analysis showed that general negative affect, but not body-specific negative affect, mediated the association from mother-daughter negative body talk to disinhibited eating behaviors (emotional and external eating). Conversely, body-specific negative affect, but not general negative affect, mediated the association from negative body talk to restrained eating behaviors. Our findings suggest there are distinct affective mechanisms that mediate the relationship between mother-daughter negative body talk and restrained versus disinhibited eating behavior. Future work should continue to explicate the role of general and body-related negative affect in different eating behaviors.

An individual-based model for direct and indirect transmission of chronic wasting disease in free-ranging white-tailed deer

Chronic wasting disease (CWD) is an infectious prion disease that infects members of the Cervidae family (i.e., deer) resulting in widespread ecological, economic, and recreational ramifications. We introduce a spatially explicit individual-based model (IBM) that integrates individual deer movement and behavior with population and disease dynamics to forecast CWD in populations of free-ranging white-tailed deer (Odocoileus virginianus). We use a Susceptible-Exposed-Infectious-Dead (S-E-I-D) epidemiological framework to explore spatiotemporal dynamics of CWD within an agriculturally dominated area in Michigan, USA. The IBM results closely mimicked documented short- and long-term dynamics of white-tailed deer populations and CWD in the Midwestern, USA. We applied pattern-oriented modeling using annual apparent CWD prevalence rates reported by Midwestern state wildlife agencies to validate the disease model. The introduction of a single infected deer to the modeled landscape (93 km2) led to an outbreak of CWD in 100 out of 350 model simulations (29 %); prevalence never exceeded 1.47 % for repetitions where the outbreak ended. For the 100 simulations where disease persisted, the deer population declined by 87 % by year 50 following initial introduction of CWD. Mean (±SD) prevalence after 5, 10, 25, and 50 years was 1.1 % (±1.0 %), 3.4 % (±3.3 %), 46.5 % (±18.8 %), and 51.8 % (±18.1 %), respectively, which highly correlated (r = 0.99) with annual CWD prevalence reported in Wisconsin white-tailed deer populations for years 1–21 post initial detection. Combined with a global sensitivity analysis, the IBM indicated that prevalence of CWD at year 20 was most sensitive to harvest rate of yearling and adult female deer and least sensitive to prion shedding rate, prion half-life, and deer group numbers, indicating that deer population parameters were more influential than disease parameters on CWD dynamics. Our IBM serves as a tool to explore and better understand indirect and direct transmission of CWD within free-ranging cervid populations. Users of this model can adjust parameter values to explore how interactions among individual deer and between deer and their environment affect CWD dynamics. This IBM also serves as a framework for applying and assessing spatially and temporally explicit management scenarios.

Identifying individual social needs during intake for diabetes Self-Management education and support services in the Detroit, Michigan area

The American Diabetes Association has recommended that diabetes self-management education and support (DSMES) teams improve diabetes outcomes by identifying and responding to patients’ social needs. This study examines demographic patterns in how hemoglobin A1c (A1c) is related to individual social needs, reported urgency of those needs, and interest in obtaining assistance. A total of 1125 unique persons who had been referred for DSMES and had completed a social needs screener via our electronic medical record were included. The majority (51.9 %) had an A1c < 8 % at their most recent assessment and most respondents (52.5 %) reported having at least 1 unmet social need (n = 591), Those who reported having at least 1 social need, tended to have higher A1c levels compared with those who reported no social needs (median of 8.0 % versus 7.7 %; p < 0.05). Among Black individuals the associations were stronger (median A1c of 8.2 % among those with versus 7.2 % among those without a reported social need; p < 0.05). However, among White individuals, there was no difference in A1c between these two groups. Among those who reported a social need, those who also reported they needed assistance (35.7 %) tended to have higher A1c levels than those who did not (median 8.3 % versus 7.8 %; p < 0.10). This relationship did not vary by race. Ongoing study of the relationship between unmet social needs and glycemic control is warranted to help identify effective clinical workflows to help providers incorporate consideration of social needs into their medical decision making.

Berries without Bugs: Recreational Foraging and a Fruit Fly Threat in Rural Michigan

Recreational foraging is an important cultural activity in the rural region of Michigan’s Upper Peninsula. During the summer of 2019, an exploratory survey was conducted of foragers in the Keweenaw Peninsula area of Michigan’s Upper Peninsula to identify local knowledge of berries and a new invasive fruit fly, spotted wing drosophila (SWD, Drosophila suzukii). SWD infests fruit before it is harvested, hastening ripening and potentially causing the fruit to spoil more quickly than might be expected. Research studying recreational foraging in the US has primarily focused on the study of urban areas. In addition, research studying SWD???s impact on berry production has largely focused on commercial cultivation rather than foraged harvesting in mixed woodlands. The majority of our respondents began picking berries in their youth and have continued throughout their life, emphasizing the importance of berry foraging within the local culture. Furthermore, many of the respondents confirmed that they pick berries as a cost-saving way to obtain healthy food, which could negatively be impacted by the fruits spoiling more quickly. In conclusion, most respondents were unfamiliar with SWD. Our findings suggest additional research studying the cultural and economic impacts of SWD is needed to inform adaptive foraging practices and SWD infestation prevention.

A broad wastewater screening and clinical data surveillance for virus-related diseases in the metropolitan Detroit area in Michigan

BackgroundPeriodic bioinformatics-based screening of wastewater for assessing the diversity of potential human viral pathogens circulating in a given community may help to identify novel or potentially emerging infectious diseases. Any identified contigs related to novel or emerging viruses should be confirmed with targeted wastewater and clinical testing.ResultsDuring the COVID-19 pandemic, untreated wastewater samples were collected for a 1-year period from the Great Lakes Water Authority Wastewater Treatment Facility in Detroit, MI, USA, and viral population diversity from both centralized interceptor sites and localized neighborhood sewersheds was investigated. Clinical cases of the diseases caused by human viruses were tabulated and compared with data from viral wastewater monitoring. In addition to Betacoronavirus, comparison using assembled contigs against a custom Swiss-Prot human virus database indicated the potential prevalence of other pathogenic virus genera, including: Orthopoxvirus, Rhadinovirus, Parapoxvirus, Varicellovirus, Hepatovirus, Simplexvirus, Bocaparvovirus, Molluscipoxvirus, Parechovirus, Roseolovirus, Lymphocryptovirus, Alphavirus, Spumavirus, Lentivirus, Deltaretrovirus, Enterovirus, Kobuvirus, Gammaretrovirus, Cardiovirus, Erythroparvovirus, Salivirus, Rubivirus, Orthohepevirus, Cytomegalovirus, Norovirus, and Mamastrovirus. Four nearly complete genomes were recovered from the Astrovirus, Enterovirus, Norovirus and Betapolyomavirus genera and viral species were identified.ConclusionsThe presented findings in wastewater samples are primarily at the genus level and can serve as a preliminary “screening” tool that may serve as indication to initiate further testing for the confirmation of the presence of species that may be associated with human disease. Integrating innovative environmental microbiology technologies like metagenomic sequencing with viral epidemiology offers a significant opportunity to improve the monitoring of, and predictive intelligence for, pathogenic viruses, using wastewater.

Association between serum 25-hydroxyvitamin D and antimüllerian hormone levels in a cohort of African-American women

ObjectiveTo examine the association between serum 25-hydroxyvitamin D [25(OH)D] and ovarian reserve as measured by antimüllerian hormone (AMH). DesignCross-sectional study. SettingDetroit, Michigan area. SubjectsData were obtained from a prospective cohort of self-identified Black/African-American women aged 23-35 years at the time of enrollment (N=1593), had no prior diagnosis of polycystic ovary syndrome (PCOS), were not currently pregnant, and were not missing AMH or 25(OH)D measures. ExposureSerum 25(OH)D. Main outcome measureSerum AMH was the main outcome. Linear regression was used to examine the associations between categorical 25(OH)D (<12 ng/mL, 12-<20, 20-<30, ≥30) and continuous natural log-transformed AMH. Associations between 25(OH)D and high (upper 10th percentile: >7.8 ng/mL) or low AMH (<0.7 ng/mL) were estimated with logistic regression. Models were adjusted for age, age-squared, BMI, hormonal contraceptive use, smoking, and exercise. ResultsThe 25(OH)D levels were low; 70% of participants were below 20 ng/mL. In fully-adjusted models, compared to 25(OH)D levels <12 ng/mL, those with 25(OH)D levels of 12-<20, 20-<30 and ≥30 ng/mL had an AMH level that was 7% (95% CI: -4, 20) , 7% (95% CI: -6, 22), or 11% higher (95% CI: -7, 34), respectively. Moreover, these groups had a lower odds of having low AMH (OR[95% CI): 0.63 (0.40, 0.99), 0.60 (0.34, 1.07), 0.76 (0.35, 1.65), respectively, and the highest category of 25(OH)D had a higher odds of having high AMH, (OR [95% CI]: 1.42 [0.74, 2.72]). Exclusion of participants with either irregular cycles or very high AMH (>25 ng/mL), did not alter the associations. ConclusionTaken together, these results indicate that higher levels of 25(OH)D are associated with a slightly higher AMH, a lower odds of low AMH, and a higher odds of high AMH. This evidence is weak, however, since only a small percentage of participants had high 25(OH)D. Future studies should examine populations with a wide distribution of 25(OH)D levels (both high and low), with a clinical trial design, or with longitudinal measures of both 25(OH)D and AMH.

S10-1 Research on sub-national initiatives in HEPA policy making from Europe, Japan and the USA

Abstract The importance of local governments' engagement in physical activity promotion at local level has been acknowledged and advocated by the World Health organization in documents such as: “Promoting physical activity and active living in urban environments: the role of local governments” or “Global action plan on physical activity 2018–2030: more active people for a healthier world”. However, given the relative “youngness” of the physical activity policy research domain, the local level initiatives have been underrepresented in the scientific literature. The current symposium aims to present a number of diverse initiatives to promote health enhancing physical activity at sub-national level, each having a very unique context and approach. The paper from Eastern Michigan University presents the actions taken to implement Active People, Healthy Nation (APHN) program in geographic areas in Michigan where the priority population (Asian Americans) lives and the outcomes of this initiative. The contribution from Japan describes the process of developing and applying the L-PAT (local policy audit tool), an instrument comprising 11 items based on WHO’s HEPA Policy Audit Tool (HEPA PAT) and the results of this survey within 47 Japanese prefectures and the C-PAT (city policy audit tool), a 6 items tool, in a selection of 272 Japanese municipalities. The EU study presented in this symposium comprises the results of evaluation, using the CAPLA- Santé, a validated instrument, of local HEPA policies in 4 selected municipalities, one from each of the following countries: Finland, France, Germany, Romania and from one municipality in Japan. The responsibilities of local authorities in health promotion and protection are undeniable. The way the authorities manage to fulfil these responsibilities is gaining more and more interest from various stakeholders from local level activists to researchers and policymakers at national and international level. Local communities are increasingly stimulated to contribute to their own wellbeing, so data on the status quo and progress is needed more than ever. The initial discussion points of the symposium will focus on strengths and weaknesses of the initiatives presented, as well as the potential for knowledge exchange and replication &amp; scaling-up.

High-resolution air quality simulations of ozone exceedance events during the Lake Michigan Ozone Study

Abstract. We evaluate two high-resolution Lake Michigan air quality simulations during the 2017 Lake Michigan Ozone Study campaign. These air quality simulations employ identical chemical configurations but use different input meteorology. The AP-XM configuration follows the U.S. Environmental Protection Agency (EPA)-recommended modeling practices, whereas the YNT_SSNG employs different parameterization schemes and satellite-based inputs of sea surface temperatures, green vegetative fraction, and soil moisture and temperature. Overall, we find a similar performance in the model simulations of hourly and maximum daily average 8 h (MDA8) ozone, with the AP-XM and YNT_SSNG simulations showing biases of −11.42 and −13.54 ppbv (parts per billion by volume), respectively, during periods when the observed MDA8 was greater than 70 ppbv. However, for the two monitoring sites that observed high-ozone events, the AP-XM simulation better matched observations at Chiwaukee Prairie, and the YNT_SSNG simulation better matched observations at the Sheboygan Kohler-Andrae (KA) State Park. We find that the differences between the two simulations are largest for column amounts of ozone precursors, particularly NO2. Across three high-ozone events, the YNT_SSNG simulation has a lower NO2 column bias (0.17×1015 mol cm−2) compared to the AP-XM simulation (0.31×1015 mol cm−2). The YNT_SSNG simulation also has an advantage in that it better captures the structure of the boundary layer and lake breeze during the 2 June high-ozone event, although the timing of the lake breeze is about 3 h too early at Sheboygan. Our results are useful for informing an air quality modeling framework for the Lake Michigan area.

Understanding the burden of colorectal cancer in a three-county rural region of Michigan: an ecological analysis of incidence, mortality, and risk factors.

Our aim was to identify whether known colorectal cancer (CRC) risk factors contribute to the high CRC burden in Michigan's Thumb region, a 3-county agricultural rural area in eastern Michigan. We examined county-level invasive CRC incidence and mortality rates (2000-2017) from the Michigan Cancer Surveillance Program and county-level data on CRC risk factors from publicly available datasets. Prevalence of CRC risk factors in the Thumb region were compared to Michigan's other rural and urban regions using ANOVA (Analysis of Variance) tests. Multivariable linear regression models with stepwise selection were used to assess whether living in the Thumb region was associated with increased CRC incidence, mortality, and late-stage diagnoses after accounting for other risk factors. Living in the Thumb region (β = 10.4, p = 0.0003), obesity (β = 36.9, p = 0.04), and an unhealthy food environment (β = -2.7, p = 0.003) were associated with higher CRC incidence. Smoking (β = 67.3, p < 0.0001), being uninsured (β = -29.9%, p = 0.03), living in the Thumb region (β = 2.47, p = 0.03), lower colonoscopy screening (β = -0.14, p = 0.01), and older age (β = 0.11, p = 0.006) were associated with higher CRC mortality. The percent of late-staged CRC diagnoses was significantly lower in the Thumb region than other rural and urban areas of the state (52.9%, 58.3%, and 54.6%, respectively, p = 0.03). Findings suggest that living in Michigan's Thumb region is associated with higher CRC incidence and mortality compared to Michigan's other rural and urban regions, even after controlling for known risk factors. More studies on individual-level demographic, environmental, tumor, and treatment characteristics (e.g., treatment differences, water quality, pesticide use) are needed to further characterize these findings.

Rationale and design for Healthy Hearts for Michigan (HH4M): A pragmatic single-arm hybrid effectiveness-implementation study

BackgroundThe burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery. MethodsPrimary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period. ResultsFifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26). ConclusionThis three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation.

Alcohol-related hepatitis admissions decline in 2021 after a 2020 surge attributed to the COVID-19 pandemic.

We previously investigated the impact of the COVID-19 pandemic on alcohol-related liver disease (ARLD), finding that admissions for alcoholic hepatitis (AH) increased by 50% in the summer of 2020 compared to the same period in 2016-2019. We have now expanded our analysis to consider full years' data and evaluate how rates changed in 2021. We also sought to identify factors associated with ICU admissions, need for dialysis, liver transplant evaluations, and death. Using retrospective data, we identified patients admitted to our four Detroit, Michigan area hospitals for acute ARLD for three periods pre-COVID (2016-February 2020), early COVID (June-December 2020), and late COVID (2021). Clustered logistic regression was performed to study rates of AH admissions across the three eras, where the patient was defined as the cluster and the analysis accounted for multiple encounters per cluster. A similar regression approach, univariate followed by multivariable analysis, was also used to study associations between patient characteristics and outcomes during hospitalization for AH. AH-related admissions declined significantly from the early COVID to late COVID eras (OR 0.68, 95% CL 0.52, 0.88), returning to levels similar to that of the pre- COVID period (OR 1.18, 95% CL 0.96, 1.47). In multivariable analysis, baseline MELD score was associated with ICU admission, initiation of dialysis, transplant evaluation, and death while hospitalized for AH. Female patients were at almost twice the risk of death during admission compared to male patients (aOR 1.81, 95% CL 1.1, 2.98). Increasing age was associated with slightly lower odds of transplant (aOR 0.97, 95% CL 0.94, 1) and higher odds of death (aOR 1.03, 95% CL 1.01. 1.06). After a spike in AH-related admissions during the first summer of the COVID-19 pandemic, rates declined significantly in 2021, returning to pre-pandemic levels.

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

Home visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities. To assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid. This retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023. Participation in Strong Beginnings or usual care. Preterm birth (less than 37 weeks' gestation at birth), very preterm birth (less than 32 weeks' gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days). A total of 125 252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124 166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14 984 of 124 166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (-2.2%; 95% CI, -4.1 to -0.3), very preterm birth (-1.2%; 95% CI, -2.0 to -0.4), very low birth weight (-0.8%; 95% CI, -1.3 to -0.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]). Participation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals.

Keloids, hypertrophic scars, and uterine fibroid development: a prospective ultrasound study of Black and African American women

To examine the association between keloids, hypertrophic scars, and uterine fibroid incidence as well as growth. Both keloids and fibroids are fibroproliferative conditions that have been reported to be more prevalent among Blacks than Whites, and they share similar fibrotic tissue structures, including extracellular matrix composition, gene expression, and protein profiles. We hypothesized that women with a history of keloids would have greater uterine fibroid development. A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds to detect and measure fibroids ≥0.5 cm in diameter, assess the history of keloid and hypertrophic scars, and update covariates. Detroit, Michigan area. A total of 1,610 self-identified Black and/or African American women aged 23-35 years at enrollment without a previous clinical diagnosis of fibroids. Keloids (raised scars that grow beyond the margins of the original injury) and hypertrophic scars (raised scars that stay within the bounds of the original injury). Because of the difficulties in distinguishing keloids and hypertrophic scars, we separately examined the history of keloids and the history of either keloids or hypertrophic scars (any abnormal scarring) and their associations with fibroid incidence and growth. Fibroid incidence (new fibroid after a fibroid-free ultrasound at enrollment) was assessed using Cox proportional-hazards regression. Fibroid growth was assessed using linear mixed models. The estimates for the change in log volume per 18 months were converted to the estimated percentage difference in volume for scarring vs. no-scarring. Both incidence and growth models were adjusted for time-varying demographic, reproductive, and anthropometric factors. Of the 1,230 fibroid-free participants, 199 (16%) reported ever having keloids, 578 (47%) reported keloids or hypertrophic scars, and 293 (24%) developed incident fibroids. Neither keloids (adjusted hazard ratio = 1.04; 95% confidence interval: 0.77, 1.40) nor any abnormal scarring (adjusted hazard ratio = 1.10; 95% confidence interval: 0.88, 1.38) were associated with fibroid incidence. Fibroid growth differed little by scarring status. Despite molecular similarities, self-reported keloid and hypertrophic scars did not show an association with fibroid development. Future research may benefit from the examination of dermatologist-confirmed keloids or hypertrophic scars; however, our data suggest little shared susceptibility for these 2 types of fibrotic conditions.

159 Bearing a higher burden: Black and Latinx community perspectives on the Impact of COVID-19

OBJECTIVES/GOALS: During earlier periods of the pandemic, Black and Latinx populations in Michigan have suffered higher rates of infection, hospitalization, and deaths when compared to Whites. We conducted this study to understand how Black and Latinx residents perceived this disproportionate burden. METHODS/STUDY POPULATION: In 2021, 40 semi-structured interviews were conducted virtually in English or Spanish with Black (n=24) and Latinx (n=16) residents in Michigan areas highly impacted by COVID-19: Genesee, Kent, Washtenaw, and Wayne counties. Using a Community-Based Participatory Research (CBPR) approach, we partnered with leaders from 15 community-based organizations and health and human service agencies to develop research questions, an interview protocol, and to interpret the data. We used the data analysis software Dedoose (ver 4.12) for inductive coding (IRR=0.81). This study is a part of the NIH Community Engagement Alliance (CEAL) Against COVID-19 initiative. RESULTS/ANTICIPATED RESULTS: Participants described the significant impact of the pandemic in terms of physical and mental health, job security, and the sheer number of deaths among loved ones. They attributed the impact to comorbidities and social determinants of health disparities exacerbated by the pandemic, including income, housing, access to healthcare, as well as systemic racism. They noted being overrepresented among frontline workers with higher exposure to COVID-19, limited or misinformation about the virus, language barriers, and difficulty with social distancing. Cultural norms that promote being in close proximity, such as intergenerational households, and loss of trusted community leaders were also noted. DISCUSSION/SIGNIFICANCE: Findings reflect the needs of Black and Latinx community members in Michigan and the discussions they feel are important to highlight. We must work strategically with partners and the community to provide transparency and effective leadership, and prioritize addressing systemic disparities in SDoH.

“It Makes a Difference!” Religion and Self-Assessed Health among Healthcare Support Professionals of Asian-Indian Origin

Objective: Mixed evidence exists in the research examining the effects of religion on health outcomes. Due to the severity of health conditions experienced by immigrants and racial and ethnic minorities in the US during the COVID-19 pandemic, this research aims to examine the influence of religious involvement on self-assessed health among healthcare support professionals of Asian Indian origin living in the US. Method: The study used oral history narratives of phenomenological tradition, obtained through interviews of 16 healthcare support professionals of Asian-Indian origin and from three different religious backgrounds. The study cohort was made up of individuals residing in the greater Detroit and Lansing areas in Michigan. Findings: Although the narratives indicated that religious engagement plays a positive role in health outcomes among care professionals, simultaneously, it was found that religion-specific meaning intersects their immigration, settlement, family expectations, and work-related experiences in the US. Future research should extend the scholarship examining gender differences in the effect of religion on self-assessed health among healthcare support professionals of Asian-Indian origin.

Biofouling of a unionid mussel by dreissenid mussels in nearshore zones of the Great Lakes.

In North America, native unionid mussels are imperiled due to factors such as habitat degradation, pollution, and invasive species. One of the most substantial threats is that posed by dreissenid mussels, which are invasive mussels that attach to hard substrates including unionid shells and can restrict movement and feeding of unionids. This dreissenid mussel biofouling of unionids varies spatially in large ecosystems, such as the Great Lakes, with some areas having low enough biofouling to form effective refugia where unionid mussels might persist. Here, we measured biofouling on mussels suspended in cages over the growing season (generally first week in June to last week of August) over 3 years in nearshore areas in Lake Erie (2014-2016), Lake Michigan (Grand Traverse Bay, 2015 and Green Bay, 2016), and Lake Huron (2015). Biofouling varied substantially by years within Lake Erie, with increasingly higher biofouling rates each year. Although dreissenid mussels are present throughout these lakes, we observed very low biofouling in Grand Traverse Bay (Lake Michigan) and Saginaw Bay (Lake Huron), with no dreissenid mussels in 8 of 9 sites across these two bays. Sampling in the rivermouth of the Fox River (Wisconsin) and the Maumee River (Ohio) both showed very high biofouling in areas adjacent to the outlet of these tributaries into Green Bay and Maumee Bay (Lake Erie), respectively. These watersheds are dominated by agriculture, and we would expect high growth of primary producers (i.e., mussel food) and primary consumers (unionids and zebra mussels) in these areas compared to the other sampled bays or the open waters of the Great Lakes.

Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study

Fibroid treatments that have few side-effects and can preserve fertility are a clinical priority. We studied the association between serum vitamin D and uterine fibroid growth, incidence, and loss. A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds, measure 25-hydroxyvitamin D (25(OH)D), and update covariates. Detroit, Michigan area. Self-identified African American or Black women aged 23-35 at enrollment without previous clinical diagnosis of fibroids. Serum 25(OH)D measured using immunoassay or liquid chromatography-tandem mass spectrometry. The primary outcomes were fibroid growth, as measured by change in log volume per 18 months, and fibroid incidence (first detection of fibroid in previously fibroid-free uterus). Adjusted growth estimates from linear mixed models were converted to estimated difference in volume for high vs. low 25(OH)D. Incidence differences were estimated as hazard ratios from age-specific Cox regression. A secondary outcome fibroid loss (reduction in fibroid number between visits), was modeled using Poisson regression. Covariates (reproductive and hormonal variables, demographics, body mass index, current smoking) and 25(OH)D were modeled as time-varying factors. At enrollment among 1,610 participants with ≥1 follow-up ultrasound, mean age was 29.2 years, 73% had deficient vitamin D (<20ng/mL), and only 7% had sufficient vitamin D (≥30ng/mL). Serum 25(OH)D ≥20ng/mL compared with <20ng/mL was associated with an estimated 9.7% reduction in fibroid growth (95% confidence interval [CI]: -17.3%, -1.3%), similar to the minimally adjusted estimate -8.4% (95% CI: -16.4, 0.3). Serum 25(OH)D ≥30ng/mL compared with <30ng/mL was associated with an imprecise 22% reduction in incidence (adjusted hazard ratio=0.78; 95% CI: 0.47, 1.30), similar to the unadjusted estimate of 0.84 (95% CI: 0.51, 1.39). The >30ng/mL group also had a 32% increase in fibroid loss (adjusted risk ratio=1.32; 95% CI: 0.95, 1.83). Our data support the hypothesis that high concentrations of vitamin D decrease fibroid development but are limited by the few participants with serum 25(OH)D ≥30ng/mL. Interventional trials that raise and maintain 25(OH)D concentrations >30ng/mL and then prospectively monitor fibroid development are needed to further assess supplemental vitamin D efficacy and determine optimal treatment protocols.

Bridging the implementation gap: Designing a course of action with Michigan Public Advisory Councils

The Michigan Department of Environment, Great Lakes, and Energy (EGLE) enlisted the help of three past capstone program participants through the University of Michigan, School for Environment and Sustainability (SEAS). Between 2019 and 2020, graduate students researched how Michigan Public Advisory Councils (PACs) can maximize their effectiveness and stewardship impact within the Michigan Areas of Concern (AOC) program, a regulatory program established to restore polluted water systems within Michigan. Each capstone participant provided several recommendations to achieve these goals, but converting these recommendations into solutions for decision-makers and practitioners is challenging. To address this “implementation gap,” we collaborated with ten Michigan PACs and EGLE to translate these recommendations into implementation plans. We synthesized the 24 cumulative recommendations from the previous capstone participants into a shortlist of eight, which we used throughout an interview process. We divided this process into Phase I interviews with individual PAC members and Phase II community conversations with multiple PAC members to identify each PAC's priority objectives and workshop their implementation. We analyzed interviews both as individual PACs and as a state-wide program using three main codes: progress, interest, and readiness, as well as an auto-coding process to check our work. These analyses showed that PAC members felt they had made the most progress toward recommendations related to PAC structure, community education, and partner organizations. While PAC members varied in their interview responses, most expressed interest in implementing recommendations where there was the greatest opportunity for progress: community education, life after delisting, and PAC recruitment.