Michigan Communities Research Articles

Evaluation of Pulse Oximetry Screening Rates Among the Midwife-Attended Out-of-Hospital Birth Community in Michigan.

In Michigan, pulse oximetry screening rates for critical congenital heart defects (CCHDs) are assessed for birthing hospitals but have not been assessed for the midwife-attended births that occur in the out-of-hospital birth community. This analysis was conducted to determine pulse oximetry screening rates among the midwife-attended out-of-hospital birth community in Michigan overall, and among midwives provided with loaned pulse oximeters from the Michigan Department of Health and Human Services (MDHHS). Records for midwife-attended out-of-hospital births between April 1, 2014, and December 31, 2016, were linked via probabilistic matching with newborn screening records. Pulse oximetry screening rates were calculated for the midwife-attended out-of-hospital birth population overall, by midwife, and stratified by receipt of loaned pulse oximeters from MDHHS. Births from midwives who attended 5 or more nonhospital births during the study period were included in this analysis. Of the 3410 midwife-attended out-of-hospital births, 20.8% (n = 710) reported as having received a pulse oximetry screening for CCHDs. For births attended by midwives who received pulse oximeters from MDHHS, 50.5% had pulse oximetry screening results reported, compared with 12.7% among births attended by midwives without a loaned pulse oximeter. Of the 78 total midwives, 18% (n = 14) reported pulse oximetry screening results on more than half of the births they attended. Of the 14 midwives who received a pulse oximeter from MDHHS, 50.0% (n = 7) reported screening results for more than half of all births they attended. Our findings indicate that CCHD screening rates are low among midwife-attended out-of-hospital birth community. Screening rates were higher among midwives who received a pulse oximeter from MDHHS, but fewer than half of the attended births had a reported pulse oximetry screening. Further discussions with the midwife-attended out-of-hospital birth community to better understand screening barriers may be beneficial.

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study.

Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast majority at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Department of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties. Data were collected through face-to-face interviews conducted over the course of three months (September-November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition. Residents reported knowing, on average, six other residents and approximately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents). This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in affordable senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study

Objective: Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast major­ity at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Depart­ment of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties.Methods: Data were collected through face-to-face interviews conducted over the course of three months (September- November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition.Results: Residents reported knowing, on average, six other residents and approxi­mately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents).Conclusions: This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in afford­able senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.Ethn Dis. 2019;29(Suppl 1): 201-208; doi:10.18865/ ed.29.S1.201.

Creating a community of practice among college campus food pantry directors in Michigan

ABSTRACTThere is increased awareness of hunger and food insecurity on college campuses. Recent estimates suggest that food insecurity affects as many as 4 out of 10 college students. As a result, over 650 US colleges have established campus food pantries. The College and University Pantries (CUP) research team at the University of Michigan–Dearborn has worked to create a community of practice in Michigan among campus pantry directors by hosting 2 summits designed around networking, problem-solving, and sharing best practices. This article describes the Michigan community of practice as an example for other regions doing similar work.

Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan

Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan

Placental pathology, corticotropin-releasing hormone, timing of parturition, and fetal growth in the pregnancy outcomes and community health study

Background: Identification of vascular pathologies in delivered placentas and their associations with biomarkers measured during pregnancy may elucidate mechanisms of adverse pregnancy outcomes and inform early detection and intervention strategies.Objectives: To examine associations of placental vascular pathology with birth size and timing of parturition, and to evaluate maternal midpregnancy serum corticotropin-releasing hormone (CRH) levels as a marker of the above associations.Study design: The pregnancy outcomes and community health (POUCH) Study enrolled women at 16–27 weeks of pregnancy from five Michigan communities. Histological assessments of delivered placentas and assays of CRH in maternal blood sampled at enrollment were performed in a subcohort of 1152 participants. Five placental vascular pathology constructs were formulated: Maternal–Vascular-Obstructive (MVO), Fetal Vascular–Obstructive (FVO), Maternal Vascular–disturbance of Integrity (MVI), Fetal Vascular–disturbance of Integrity (FVI), and Maternal Vascular–Developmental (MVD). A four-level outcome variable combined small for gestational (SGA) yes/no and delivery timing preterm/term; the non-SGA/term served as the referent group. In multinomial logistic regression models, the five vascular pathology groups were evaluated in relation to the outcome variable and effect sizes were compared before versus after exclusion of participants with high CRH (top quartile).Results: Adjusted odds ratios (aOR) for MVO among SGA/term and SGA/preterm were 4.1 (95% CI: 2.2, 7.9) and 8.8 (95% CI: 3.3, 23.5) respectively. Among SGA/preterm births, the aOR was attenuated by ∼40%, i.e. 5.4 (95% CI: 1.1, 26.2) after removing high CRH pregnancies. MVI and FVO were each associated with SGA/preterm, aOR = 3.7 (95% CI: 1.3, 10.3) and 10.5 (95% CI: 3.6, 30.8) respectively. Removal of high CRH pregnancies reduced the OR estimates by nearly half, i.e. MVI aOR = 1.9 (95% CI: 0.34, 10.9), FVO aOR = 6.0 (95% CI: 1.3, 28.6). MVI, FVI and MVD were each associated with greater odds of non-SGA/preterm, but the aORs showed little change after removing high CRH pregnancies.Conclusions: Obstructive placental vascular pathologies in maternal or fetal vessels are associated with SGA. High CRH levels coincided with a portion of pregnancies that share these complications, particularly among pregnancies that also ended prematurely.

Maternal serum uric acid levels in pregnancy and fetal growth

Objective: Studies of maternal serum uric acid (UA) in pregnancy focus primarily on high levels of UA, however, both low and high UA levels can be markers of oxidative stress, a biological state potentially linked to fetal growth. We therefore aimed to test whether low and high maternal serum UA levels during pregnancy are associated with atypical fetal growth (unusually small or large) measured as birthweight (BW) for gestational age.Methods: The Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th–27th week of pregnancy from 52 clinics in five Michigan communities (1998–2004). Maternal UA levels were measured in blood collected at enrollment among a subcohort of 1291 participants. Infant BW and gestational age were used to calculate gestational age-specific BW Z-score. Infants were grouped as small (SGA = BW < 10th percentile), appropriate (AGA = BW 10th–90th percentile), or large (LGA) = BW > 90th percentile) for their gestational age. Analyses considered multiple potential confounders. Linear spline or multiple linear regression models were applied to evaluate the relationship between maternal UA levels and BW Z-score overall and within SGA, AGA, and LGA groups. Model robustness was tested through bootstrap, sensitivity analysis, and cross-validation techniques.Results: The relation between maternal UA levels and BW Z-score varied by infant group. Among SGA infants, the relation was nonlinear (J-shape): both extremes of UA had lower BW Z-score with a breakpoint of 0.267 mmol/L UA (adjusted regression coefficient β = 2.32, p = .01 for lower UA; adjusted β = −37.38, p < .01 for higher UA). Among AGA infants, there was no significant association, and among LGA infants, the relation was linear (adjusted β = 2.86, p = .03).Conclusions: Future research on maternal UA levels in pregnancy may benefit from considering both very low and high levels, and identifying in utero conditions associated with the two extremes.

Maternal Socioeconomic Mobility and Preterm Delivery: A Latent Class Analysis.

Objective Growing evidence suggests that maternal socioeconomic mobility (SM) is associated with pregnancy outcomes. Our study investigated the association between maternal SM from childhood to adulthood and the risk of preterm delivery (PTD), and examined heterogeneity of associations by race/ethnicity. Methods In this study, 3019 pregnant women enrolled from 5 Michigan communities at 16-27 weeks' gestation (1998-2004) provided their parents' socioeconomic position (SEP) indicators (education, occupation, receipt of public assistance) and their own and child's father's SEP indicators (education, occupation, Medicaid status, and household income) at the time of enrollment. Latent class analysis was used to identify latent classes of childhood SEP indicators, adulthood SEP indicators, and SM from childhood to adulthood, respectively. A model-based approach to latent class analysis with distal outcome assessed relations between latent class and PTD, overall and within race/ethnicity groups. Results Three latent classes (low, middle, high) were identified for childhood SEP indicators and adulthood SEP indicators, respectively; while four latent classes (static low, upward, downward, and static high) best described SM. Women with upward SM had decreased odds of PTD (Odds ratio = 0.60, 95% confidence interval: 0.42, 0.87), compared to those with static low SEP. This SM advantage was true for all women and most pronounced in white/others women. Conclusions Maternal experiences of upward SM may be important considerations when assessing PTD risk. Our results support the argument that policies and programs aimed at improving women's SEP could lower PTD rates.

Effect of the WeCareAdvisor\u2122 on family caregiver outcomes in dementia: a pilot randomized controlled trial

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are universal and associated with multiple negative outcomes. This pilot randomized controlled trial (RCT) evaluated the effect of using the WeCareAdvisor, an innovative web-based tool developed to enable family caregivers to assess, manage, and track BPSD.MethodsThis RCT enrolled 57 dementia family caregivers from community and clinical settings in Ann Arbor, Michigan and Baltimore, Maryland. Participants were randomly assigned to immediate use of the WeCareAdvisor tool (WCA, n = 27) or a Waitlist control group (n = 30) that received the tool after a one-month waiting period. Outcomes for the caregiver and the person they were caring for were assessed at baseline (T0) and one-month followup for both the WCA (T1) and Waitlist control (T2) groups.ResultsCaregiver mean age was 65.9 ± 14.0 years old. About half (49%) were spouses. Baseline characteristics were comparable between groups except for mean caregiver confidence which was higher in the control group (WCA 35.0 ± 10.0 vs. Waitlist control 39.7 ± 6.9, p = 0.04). There were no significant differences between the WCA and control groups in characteristics of the person with dementia. After their one-month of tool use (T1), WCA caregivers showed significant within group improvement in caregiver distress (− 6.08 ± 6.31 points, t = − 4.82, p < 0.0001) and behavioral frequency (− 3.60 ± 5.05, t = − 3.56, p = 0.002), severity (− 3.24 ± 3.87, t = − 4.19, p = 0.0003) and total behavioral score (− 6.80 ± 10.73, t = − 3.17, p = 004). In the same timeframe, Waitlist control caregivers showed a significant decrease in confidence (− 6.40 ± 10.30, t = − 3.40, p = 0.002). The WCA group showed greater improvement in distress compared to the Waitlist group (T0-T1; t = − 2.49, p = 0.02), which remained significant after adjusting for site and baseline distress. There were no significant between-group differences in caregiver confidence or other secondary outcomes. After their one month of tool use (T2), the Waitlist group also showed significant improvement in caregiver distress (− 3.72 ± 7.53, t = − 2.66, p = 0.013), stress (− 0.41 ± 1.02, t = − 2.19, p = 0.037), confidence (4.38 ± 5.17, t = 4.56, p < 0.0001), burden (− 2.76 ± 7.26, t = − 2.05, p = 0.05), negative communication (− 1.48 ± 2.96, t = − 2.70, p = 0.012) and behavioral frequency (− 1.86 ± 4.58, t = − 2.19, p = 0.037); distress remained significant after adjustment.ConclusionsIn this pilot RCT, WCA use resulted in a significant decrease in caregiver distress. Future research will identify whether longer use of WCA can impact other caregiver and behavioral outcomes.Trial registrationClinicaltrials.gov identifier NCT02420535 (Date of registry: 4/20/2015, prior to the start of the clinical trial).

Creating climate change adaptation plans for rural coastal communities using Deliberation with Analysis as public participation for social learning

Public participation can foster social learning, creating environments where diverse groups can come together to dialogue about multifaceted societal and environmental issues and values. The case study uses Deliberation with Analysis, a process to integrate local residents’ knowledge and values with local climate data, to create climate adaptation plans with two rural coastal Michigan communities. Iteration of the deliberative dialogue process is critical for allowing enough time for meaningful change and constructive communication to occur. Understanding where the community is starting from is important when tensions are high or deeply held values are challenged. Older techniques may need to be used to prepare the community for full participation in a deliberative process. Case highlights include the importance of community identity; potential negative impacts of climate change proposals on land-use rights; and the importance of multiple public engagement opportunities, or iterative learning loops, in cl...

Increasing Opportunities for Health in a Southeast Michigan Community Through Local Policy Change.

Disparities in health outcomes are closely linked with social, economic, and environmental conditions. The burden of these disparities are most often experienced by racial and ethnic individuals of color, those with low income, and those who live in vulnerable communities. Local policy and systems change efforts provide a means to address health inequities and create sustainable change at the community level. The Inkster Partnership for a Healthier Community was formed in 2010 to create sustainable opportunities for health, with a special focus on diabetes prevention and management. Policy and infrastructure change efforts were documented and tracked over time and qualitative data were collected to create deeper understanding of the change efforts. Eleven policy outcomes have created sustainable change around access to health resources and services, access to healthy foods, opportunities for physical activity, diabetes prevention and management education, and increased capacity for ongoing community change.

Maternal serum uric acid levels and blood pressure during pregnancy: A community-based cohort study

ObjectiveStudies find both very low and high serum uric acid (UA) levels are related to oxidative stress and to conditions such as cardiovascular diseases and chronic kidney disease in the general population. Pregnancy studies have focused only on high maternal UA. In present study, we tested whether unusually high and low levels of maternal serum UA are associated with increases in blood pressure (BP) during pregnancy. Study designThe Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th–27th week of pregnancy from 52 clinics in 5 Michigan communities (1998–2004). UA levels were measured in maternal blood collected at enrollment from a sub-cohort of 1223 participants. BP was abstracted from prenatal medical records; these analyses used highest recorded diastolic BP (DBP) and its companion systolic BP (SBP). Mean arterial pressure (MAP) was calculated using the formula of (2 × DBP + SBP)/3. Covariates, including maternal race/ethnicity, age at enrollment, education level, medical insurance status, body mass index before pregnancy, parity, smoking during pregnancy, alcohol use during pregnancy, and gestational week at blood collection, were considered as potential confounding variables. Associations between UA levels and BP were evaluated with linear spline or multiple linear regression models. Models’ robustness was examined with bootstrap estimation of variance, sensitivity analysis, and 10-fold cross-validation. ResultsBoth DBP and MAP had a J-shaped relationship with maternal UA; the breakpoints (nadirs) were 0.153 and 0.161 mmol/L UA, respectively. For DBP versus UA, adjusted regression coefficient (β) = −95.67 (standard error (SE) = 37.67 and p = 0.01) for the left and adjusted β = 48.95 (SE = 9.56 and p < 0.01) for the right; for MAP versus UA, adjusted β = −58.48 (SE = 31.42 and p = 0.06) for the left and adjusted β = 52.23 (SE = 11.39 and p < 0.01) for the right. Maternal SBP followed a positive linear trend with UA levels (adjusted β = 37.75, SE = 12.93, and p < 0.01). All results were robust. ConclusionExtreme high and low maternal serum UA levels may be informative in studying maternal blood pressure during pregnancy.

Latinas and Latinos in the Midwest: Pocos, pero bien Contados

Latinas and Latinos in the Midwest:Pocos, pero bien Contados Ruben O. Martinez (bio) and Juan D. Coronado (bio) Near midnight on July 5, 2017, a 47-year-old Latino male walking on a sidewalk in a commercial area in Lansing, Michigan, was assaulted by two White Americans in what was investigated as a hate crime. The suspects, motivated by the hostile social and political environment of today, defined by nativism and racial intolerance, yelled, "Trump hates you" at the victim as they pummeled him into a bloody mess. The two male perpetrators then stapled a note on the victim's chest that read, "Go back to Mexico, Wetback." Within two weeks of the brutal crime, on July 18, representatives from the Latino community gathered with other community leaders, along with elected and appointed officials to publically condemn the cowardly act of hatred and violence. The event occurred because Latino and Latina leaders called for public condemnation; up to that point elected officials had remained silent on the incident. Although the Latino community in Michigan, as in the Midwest (apart from Chicago), may not be as large as in other parts of the country, the condemnation on that given day was firm and resounding—Lansing is a welcoming city, not a city of hate. Como dicen en Mexico, Pocos, pero bien contados. (As they say in Mexico, "Few, but very well represented.") Pocos, pero bien contados is an accurate description of the Latino/a population in Michigan and in the rest of the Midwest. Despite representing only 5% of the population in Michigan and 7.6% in the entire Midwest (mostly in Chicago), there is a handful of Latinas and Latinos that are keenly aware of the challenges facing their communities.1 As in all minority communities there are community leaders who step up to resist acts of oppression and civil and human rights violations. Such is the case with Latinos and Latinas in the Midwest, who, despite their relatively low numbers, pursue progressive change in their neighborhoods, cities, states, and region. Across the Midwest, statewide Latino-focused commissions concentrate on issues confronting Latino communities. In today's highly polarized political climate, which is in direct response to the stagnant economy of recent years and the demographic "change of colors" in the United States, Latinos face a nativist pushback by White Americans who view them, regardless of citizenship, not only as a threat to "traditional" American culture but as "outsiders" taking jobs from White Americans. Trump's slogan "Make America Great Again" represents the nativist sentiments held by many Americans in a period of increasing income and wealth inequality brought about by the policies of free-market ideologues. Today, Latinos are a visible and growing minority population, one that has been in the Midwest for over a century.2 Their largest numbers were initially in the Kansas City metro area in the first third of the last century, but presently Chicago and its surrounding suburbs have the largest concentration. These days, Latinos are found throughout the 12 Midwestern states (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin); they are in urban and rural areas, in factories, service occupations, food processing plants, transportation, and educational institutions, to name but a few. Their presence continues to grow daily, and will continue to do so through natural increase, as they are a relatively young and fertile population. Further, because of their relative youth, they tend to have higher labor participation rates than White Americans, contributing significantly to the economy. Finally, Latinos embrace the democratic values that are the foundation of the American state, and thereby contribute to its preservation. Despite the public view that Latinos are newcomers to the Midwest, they actually have an extensive history in the region dating back to the sixteenth century—1541 to be exact—when Francisco Coronado visited the area in present-day Kansas and Hernando de Soto explored the Mississippi River in areas that are part of present-day Midwestern states.3 By the turn of the nineteenth century the newly established Santa Fe Trail linked Independence, Missouri, with Santa Fe, New Mexico, establishing overland economic ties with [End Page...

Round goby and zebra mussel interactions with darters in a warm-water stream community in southern Michigan, USA

The non-indigenous round goby (Neogobius melanostomus) entered the Flint River, Michigan, USA around 1996 while zebra mussels (Dreissena polymorpha) invaded in late 1998. We wanted to identify if there were round goby or darter (Etheostoma/Percina spp.) diet or density alterations by comparing 1998 data with our 2002 data after mussel colonization. Chironomids dominated the round goby’s pre-zebra mussel diet in August 1998 (89% by number), followed by hydropsychids (10%). After zebra mussels arrived, diets diversified; chironomids declined to 52%, hydropsychids stayed the same, gastropods were more prominent (22%) and 4% were zebra mussels. Data from a site upriver (with no round gobies or zebra mussels) showed darters consumed mostly chironomids (49%), mayflies (11%) and hydropsychids (9%), suggesting reliance on chironomid prey and other interactions compromised the ability of darters to coexist with round gobies downstream, since only one of three species present during 1998 was collected in 2002. Benthic assemblages on rocks changed dramatically (R-values =0.95) from 1998 to 2002. Blackside darter (Percina maculata) density in the presence of round gobies increased eightfold compared with 1998. We hypothesized zebra mussels fostered the growth of macrophytes, resulting in odonates composing 42% by volume of blackside darter diets in 2002 compared with 10% in 1998. Diet overlaps between small and large round gobies and blackside darters were high (Schoener Index =0.55–0.59, R-values =0.11–0.24), suggesting potential negative competitive interactions. Zebra mussel-mediated ecosystem changes may have decreased interspecific competition for food with blackside darters, allowing coexistence with round gobies. Native darters with varied diets feeding in mid-water, are most likely to coexist with round gobies, especially where dreissenids potentially mediate competitive interactions.

Drug-Free Schools and Communities Act Compliance at Michigan Community Colleges

ABSTRACTIn 1989, Congress passed the Drug-Free Schools and Communities Act Amendments to address illegal alcohol and drug abuse on college campuses. To receive federal funding, each college must comply by implementing an alcohol and drug prevention program, but the federal government and some colleges have paid little attention to this policy. Recently, the Department of Education vowed to intensify its scrutiny of colleges and has begun issuing fines for noncompliance. There have been no studies on this topic in over 20 years, leaving community college administrators, in particular, without guidance on how to implement the required programs. In this study, I analyzed public reports from Michigan community colleges to evaluate compliance with the Drug-Free Schools and Communities Act and to examine their alcohol and drug programs. I found that 21 of Michigan’s 28 community colleges partially complied with the Act, only two implemented all the required mandates, and five were noncompliant. Most notably, colleges failed to collect substantive programmatic outcomes data, and few offered evidence-based alcohol and drug prevention programs to students. I provide rationale for why colleges should invest in improving compliance and the quality of alcohol and drug programs, and I offer seven recommendations to community college administrators on how to do so.

“Our Hope and Our Protection”: &lt;em&gt;Misko-biiwaabik&lt;/em&gt; (Copper) and Tribal Sovereignty in Michigan

"Our Hope and Our Protection"Misko-biiwaabik (Copper) and Tribal Sovereignty in Michigan Erik M. Redix (bio) In 2000 the Smithsonian denied the request of the Keweenaw Bay Indian Community in Michigan's Upper Peninsula to repatriate a three-thousand-pound copper boulder that was removed from the shores of Upper Michigan's Ontonagon River in 1843. The Keweenaw Bay Indian Community (KBIC) consists of two historic bands of the Lake Superior Ojibwe: the L'Anse and Ontonagon bands. KBIC argued that the boulder was a sacred object utilized for purification by practitioners of Ojibwe Midewiwin prior to beginning ceremonies. The Smithsonian ruled that KBIC failed to provide evidence that the boulder was a sacred object as defined by the 1990 Native American Graves Protection and Repatriation Act (NAGPRA) as it was not utilized directly in ceremonies.1 NAGPRA was passed primarily to return human remains to Native communities. It is important to remember that the legislation only applies to publicly funded institutions. Despite this, the legislation has been relatively effective in the repatriation of human remains. However, the burden of proof for repatriation lies with tribes, not the institution housing the object. This has resulted in contestations over what constitutes "sacred" objects under NAGPRA, which defines them as "specific ceremonial objects which are needed by traditional Native American religious leaders for the practice of traditional Native American religions by their present-dayadherents."2 If the federal government was truly committed to decolonization and tribal sovereignty, the burden would fall on the federal government to prove why it should keep objects when a tribe petitioned for repatriation; the tribe would then review the federal request. The Keweenaw Bay Indian Community and other tribes are sovereign nations and should be vested [End Page 224] with the right to determine what should be returned to them. Linguistic evidence demonstrates that the Ojibwe viewed the Ontonagon boulder as a living being, which bolsters both the moral and specific legislative reasons why it should be returned. However, the Ontonagon boulder is not just an object in a discussion of tribal sovereignty. Many sources suggest that Ojibwe leaders saw the boulder as a source of their sovereignty. In the nineteenth century, leaders of the Ontonagon band consistently articulated to American officials that they saw copper as an important aspect of their sovereignty, calling it "our hope and our protection." From its removal from Michigan in 1843 to the denial of the Smithsonian to repatriate it in 2000, the Ontonagon boulder tells an important story of how the Ojibwe experienced colonialism. Removal was central to American colonialism. It was not just people who were removed, but objects and resources were also separated from tribal homelands. During the time of the removal of the boulder, Ontonagon band leaders knew that what threatened Ojibwe sovereignty most was American desire for copper, not land. Most Ojibwe people were not directly evicted from their lands by white settlement during the era of treaty making. Instead, American desire to exploit Ojibwe resources such as copper posed the greatest threat to Ojibwe sovereignty during this time. While there was not widespread white settlement in Ojibwe territory in the decades following land cession treaties, the resources exploited in the region were critical for American expansion across the continent. Historian David R. Wrone argues: They provided several of the essential ingredients for the industrial transformation of late nineteenth century and early twentieth century America. The ores of the Mesabi enabled the steel mills of Pittsburgh to flourish, the copper of the Keewnanh [sic] poured into wires made the telephone system possible. Power sites created paper mills, part of the industrial glory of Wisconsin. The lakes and fish offered a recreational paradise.3 Exploration of Upper Michigan's copper preceded and fueled American attempts to extend control over the lands of the Lake Superior Ojibwe. In the decades immediately following the Civil War, three-fourths of all copper produced in the United States came from Upper Michigan during an era when the United States produced half the world's copper. It all started with the removal of the Ontonagon boulder. [End Page 225] the ontonagon band and copper The Ontonagon band was one of the...

Indigenous water histories I: recovering oral histories, interpreting Indigenous perspectives, and revealing hybrid waterscapes

This special issue attempts to shed new light on salient but neglected aspects of water history, “Indigenous water histories.” In this first of two journal issues dedicated to this topic, we present five articles that are pertinent to three themes that Water History has not entirely or substantially dealt with before: the use of oral history, the interpretation of indigenous perspectives, and the emphasis on the hybrid/divergent aspects of waterscapes. Readers, however, will see that these new themes are largely complementary to the most popular topics this journal has explored before, such as the histories of reclamation projects, water distribution, management, pollution, and politics. Geographically, this collection offers a broad coverage of Indigenous water issues by encompassing cases from the United States (U.S.), Mesoamerica, eastern Timor Leste, and northern and western Australia. Valoree S. Gagnon traces the changes and continuity of Ojibwe Gichigami (Ojibwa’s Great Sea) water narratives and fishing rights among the Keweenaw Bay Indian Community in Michigan, the U.S. Teresa Cavazos Cohn and her coauthors discuss changes in riparian plants and landscapes in the Wind River watershed of Wyoming, the U.S., and the implications of these changes for the Eastern Shoshone and Northern Arapaho Tribes. The focus of these two articles on water history germane to fish and plants should be new for readers of Water History.

Differences in Cardiovascular Disease Risk Factors and Health Behaviors Between Black and Non-Black Students Participating in a School-Based Health Promotion Program.

To compare cardiovascular disease (CVD) risk factors of black and non-black children participating in Project Healthy Schools (PHS), a school-based wellness program. Participants were surveyed and participated in physiological screenings pre- and post-PHS intervention. Middle schools in 4 Michigan communities of varying socioeconomic status. A total of 3813 sixth-grade students comprised the survey sample, and 2297 sixth-grade students comprised the screening sample. Project Healthy Schools is a school-based intervention designed to reduce the risk of obesity and CVD in children through the promotion of healthy eating and physical activity. Physical examination, blood test, and self-reported survey data on dietary habits, physical activity, and sedentary behaviors were collected pre- and post-PHS. Paired and independent t tests were used for physiologic variables. Wilcoxon sign-rank and rank-sum tests were used for survey variables. At baseline, blacks had a higher percentage of overweight/obese students (43% vs 34%; P < .0001) and demonstrated poorer health habits than non-blacks; however, non-blacks had poorer lipid profiles. At follow-up (post-PHS intervention), both groups demonstrated significant improvements in physiological measures and health behaviors. Despite disparities between the groups at both baseline and follow-up, changes seen post-PHS intervention were beneficial in both groups. These results suggest that early intervention for risk factor modification is possible and may be of great importance in the prevention of CVD, particularly in high-risk groups.

Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices

We examined the frequency of followup prostate specific antigen testing and prostate biopsy among men treated with active surveillance in theacademic and community urology practices comprising MUSIC (Michigan Urological Surgery Improvement Collaborative). MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data on all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered active surveillance and had at least 2 years of continuous followup. After determining the frequency of repeat prostate specific antigen testing and prostate biopsy, we calculated rates of concordance with NCCN Guidelines® recommendations (ie at least 3 prostate specific antigen tests and 1surveillance biopsy) collaborative-wide and across individual practices. We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup. Among the 431 men (84%) who remained on active surveillance for 2 years 132 (30.6%) underwent followup surveillance testing at a frequency that was concordant with NCCN® (National Comprehensive Cancer Network®) recommendations. At the practice level, the median rate of guideline concordant followup was 26.5% (range 10% to 67.5%, p<0.001). Among patients with discordant followup, the absence of followup biopsy was common and not significantly different across practices (median rate 82.0%, p = 0.35). Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy. These data highlight the need for standardized active surveillance pathways that emphasize the role of repeat surveillance biopsies.

A glance behind and a look ahead: history and future of a regional biosolids authority

Regional utility, water or wastewater partnerships have existed for many years with varying degrees of success. In the early 2000's, leaders from two west Michigan communities came together with the idea of forming a regional biosolids program. Drivers for this effort primarily included increasing costs of existing programs, loss of land application sites, and age/condition of existing facilities. A project team was formed, a consultant was hired, and by 2004 the Cities of Grand Rapids and Wyoming formally signed the Articles of Incorporation forming the Grand Valley Regional Biosolids Authority (GVRBA). In 2009, a regional dewatering facility became operational. The economic downturn of 2007–2011 resulted in significant deviance from projected volume and costs, yet each community remains committed to the GVRBA and has recently begun incorporating the concept of sustainability into the program. The history, key drivers, benefits, disadvantages, and future of the GVRBA are further explored in this paper.