Residents Of Flint Research Articles

Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme.

Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.

Smoking, Stress, and Health Risk Behaviors During the Early Phase of COVID-19 Lockdowns Among Residents of Flint, Michigan

Abstract: Food insecurity and smoking commonly co-occur in underserved populations, exacerbating health disparities. This study assesses smoking and its associations with mental health and health risk behaviors among residents of Flint, Michigan in the early phase of COVID lockdowns. The survey captured smoking status, mental health indicators, and health risk behaviors among 106 who had financial needs and limited mobility and received community nutritional services. Comparisons by demographics showed that those who lived alone, used marijuana, and had frequent alcohol drinking tended to smoke more than their counterparts. Results from logistic regression showed that those with high levels of stress, marijuana use, and alcohol consumption were more likely to smoke. Living alone was associated with smoking and health risk behaviors. This research suggests the need for smoking prevention and community health practices addressing stress, health risk behaviors, and circumstances that might drive the association with living alone such as loneliness.

Predatory Inclusion and the Flint Water Crisis

In 2014, residents of Flint, Michigan began to experience the first effects of the years-long Flint water crisis. Mismanagement of crumbling infrastructure by the city and state and severe austerity measures exposed thousands of children to toxic levels of lead in the drinking water. While blame for this is often assigned to the officials in charge at the time, the history of Flint reveals a decades-long pattern of private and public collusion in the exploitation of city residents. The predominantly Black population of Flint has been tethered to derelict properties and excluded from opportunity through a process that Keeanga-Yamahtta Taylor has termed “predatory inclusion.” In Race for Profit: How Banks and the Real Estate Industry Undermined Black Homeownership, she provides a productive addition to the necessary conversations on how the real estate industry and its racial and class dimensions factor into the creation of environmental crises.

Stress and Health Status Among Members of a Disadvantaged Community in Flint, Michigan in the Early Phase of the COVID-19 Pandemic.

The COVID-19 pandemic creates psychological concerns and stress and its impacts are more extreme for those with health concerns residing in socially and economically disadvantaged communities, such as residents of Flint, Michigan. This study assesses the stress level among people who received community assistance in the first 3 months of COVID lockdowns. Further, it examines associations between stress and physical and mental health status. We measured perceived stress, health concerns, mental distress, and perceived physical and mental health from 106 survey respondents. Comparisons of stress levels by demographics showed that females, high school graduates, and homeowners had higher stress levels than its counterparts. Results from general linear models showed that stress was highest among those with high levels of psychological distress, perceived poor mental health, and more health concerns. The associations between poor perceived physical health and stress were marginal. Homeowners and high school diploma holders showed lower stress levels. This research suggests community health practices tailored to community characteristics and culture will have the greatest impact on stress and health problems in underserved communities.

P056 Challenges and Successes of a Pediatric Produce Prescription Program During COVID-19

BackgroundA large pediatric clinic in Flint, Michigan, a low-income, urban community, implemented a fruit and vegetable prescription program for youth to address enduring challenges with food access and food insecurity. Approximately 18 months after this prescription program was introduced, the State of Michigan issued a “stay home, stay safe” executive order in response to the COVID-19 pandemic.ObjectiveThis study sought to investigate perceived changes to access and utilization of fruit and vegetable prescriptions as well as general changes in the food environment that resulted from the pandemic and related executive order.Study Design, Setting, ParticipantsData were collected using semi-structured telephone interviews with caregivers of children (8-18 years of age) who received at least one fruit and vegetable prescription.Measurable Outcome/AnalysisInterview recordings were transcribed verbatim for textual analysis. Using thematic analysis, qualitative data was examined to identify patterns across transcripts and formulate common themes. Interviews concluded when data saturation was reached.ResultsFifty-six caregivers participated in interviews (mean age, 41.3 ± 10.3 years). The majority were female (91%), African American (70%), and residents of Flint (75%). Four recurrent themes, centered around changes in the food environment resulting from COVID-19, emerged: produce prescription access and utilization; food access constraints; food shopping adjustments; and food insecurity stress.ConclusionsThe current study highlights stark ramifications of COVID-19, particularly among vulnerable families, many of whom were at elevated risk for food insecurity and hunger prior to the pandemic. Perceived consequences of COVID-19 included increased anxiety related to food shopping and food insecurity alongside challenges with access and utilization of a fruit and vegetable prescription program as pediatric clinics moved to virtual healthcare visits and farmers’ markets closed.FundingMichigan Health Endowment Fund

Community Science as Resistance to Neoliberal Scientific Praxis.

Flint is a site of resistance to neoliberalism specifically because of the actions of Flint residents. The impacts of this organizing are due, in part, to sustained efforts to reimagine how communities can contribute to scientific knowledge production. We argue that Flint residents' efforts to advance a community-driven research (CDR) agenda represent an important and successful resistance to neoliberal scientific regulatory practices. We present Flint as a case study in CDR as a form of resistance. This article uses participatory observation within community-based research and draws from the personal experiences of the research team as long-term and lifelong residents of Flint who were actively involved in different aspects of community mobilizing during the water crisis. We highlight Flint's rich and sustained community-based participatory research history, resident-led data collection efforts to assess the environmental and health conditions, a resident-led effort to tell the story of the water crisis from the residents' perspective, and recent efforts to develop and advance a CDR model. Community-led research efforts in Flint follow Leitner et al.'s typology of contesting neoliberalism through opting in to neoliberal science to advance community needs, collecting data to support direct opposition through protest and mobilization, creating alternative knowledge frames, and using CDR to disengage from the traditional scientific model. Through CDR, Flint residents work in direct resistance to the tacit integration of neoliberal values into science and alternatively advance community organizing as a key aspect of science toward environmental justice.

Impact of a Pediatric Fruit and Vegetable Prescription Program on Food Security and Dietary Patterns Following Two Years of Exposure

ObjectivesIn August 2018, a pediatric clinic in Flint, Michigan introduced a program that provided one $15 prescription for fresh fruits and vegetables to all patients (0–18 years of age) at the conclusion of their office visits. Prescriptions were redeemable only for fresh fruits and vegetables at a downtown farmers’ market or a local mobile market. The objective of this study was to examine changes in dietary patterns and food security among a sample of caregiver-child dyads who participated in this fruit and vegetable prescription program for two years. MethodsThis non-controlled longitudinal intervention trial included a sample of caregiver–child dyads who were exposed to the pediatric fruit and vegetable prescription program for two years. A consecutive sample of caregivers whose children were 8–18 years of age at baseline were invited to participate in the study. Dyads separately completed in-person surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription. Dyads completed the identical surveys via a secure digital platform again at approximately 24 months. Results104 caregiver-child dyads enrolled in the study and completed baseline and two-year follow-up assessments. At follow-up, most of the children (mean age 14.24 ± 2.4) were African American (66%) and residents of Flint (76%). The majority of caregivers (mean age 41.3 ± 8.9) were female (95%) and African American (69%). Among the 96 children who completed the food screener at baseline and two-year follow-up, significant improvements in mean daily intake of vegetables (p < 0.001), whole grains (p < 0.001), and dairy (p < 0.001) were reported. Improvements in caregiver-reported household food security (p < 0.001) as well as child-reported food security (p = 0.012) were also observed. ConclusionsThe current study provides evidence to support the long-term effectiveness of pediatric fruit and vegetable prescription programs. Funding SourcesMichigan Health Endowment Fund.

Predictors of COVID-19 Mortality in Residents of Flint, Michigan: Effect of Age, Gender, Smoking, and Health Plan

Background: Current literature suggests that older age, hypertension, and diabetes mellitus confer a significant increased risk of mortality among patients with COVID-19. The purpose of this study is to further characterize the predictors of mortality in patients with COVID-19 in residents of Flint, Michigan, based on variables such as gender, age, smoking status, health insurance plan, and comorbidities. Methods: Hurley Medical Center, is a 443-bed public, nonprofit, teaching medical center located in Flint, Michigan. In total, 289 consecutive adult patients (aged ≥18 years) with confirmed SARS-CoV-2 infection by nasal polymerase chain reaction (PCR), admitted and discharged from our facility from March 2020 through June 2020, were retrospectively analyzed. Results: During the 4-month study period, the overall in-hospital case fatality rate (CFR) was 18% (51 of 289), with highest CFR in the age group aged 60–69 years (36%; P = .06). Nonsurvivors tended to be older with mean age of 67 years (95% CI, 61.6–71.8) versus survivors with mean age of 60 years (95% CI, 57.7–62.4). Highest mortality was seen in patients with Medicare or Medicaid as their sole health plan (39%, P = .59). Men comprised 51% (148 of 289) of the cohort with CFR of 21% versus 14% in females. Females tended to be younger with a higher body mass index (BMI) than their male counterparts (mean age of 58 years, mean BMI of 35 in women vs a mean age of 62 and BMI of 29 in men). A higher proportion of deceased were active smokers (51%; P = .02). CFR was highest in patients with hypertension (92%,; P = .15), followed by diabetes (44%; P = .85), chronic kidney disease (CKD) (31%; P = .10), obstructive sleep apnea (OSA) (28%; P = .25), asthma (22%; P = .64), and coronary artery disease (22%; P = .34). It was lowest in patients with end-stage renal disease (3%; P = .69). Conclusions: Our study suggests trends towards higher mortality with male sex, hypertension and diabetes, along with other comorbidities. Smoking seems to be a strong predictor of mortality in this cohort. Further studies are needed to ascertain the relationship between possible risk factors with COVID-19 mortality in residents of Flint, Michigan. Describing and understanding the potential risk factors is the key to improving outcomes in this population.Funding: NoDisclosures: None

Psychological Consequences of the Flint Water Crisis: A Scoping Review.

To summarize existing literature on the mental health impact of the Flint Water Crisis. In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted. 132 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted. With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.

Credit Access and Mobility during the Flint Water Crisis

How do credit-constrained communities cope with the financial consequences of environmental crises? Beginning in April 2014, the residents of Flint, Michigan, were exposed to lead-contaminated water resulting from a series of governmental missteps. In this paper, we use the spatial distribution of lead and galvanized pipes in Flint to study the effect of the crisis on households’ financial health, including loan balances, repayment of outstanding debt, and Equifax Risk Scores, as well as on household mobility. We find that relatively more affected households, as measured by exposure to lead pipes, experienced a modest increase in the balance and frequency of past due loans. Equifax Risk Scores declined slightly on average, but more so at the bottom of the Risk Score distribution. In addition, we find that there was no effect on mobility out of the state or county, but that more affected households were more likely to move within the city when the crisis began, away from lead-pipe-dense areas.

Electrochemical Sensors for on-Site Detection of Toxic Metal Ions in Environmental Water Systems

Easy to use devices for the rapid detection of toxic metal ions in drinking water is essential for improving monitoring, identification and management of water resources. In 2014, over 100,000 residents of Flint, Michigan, were exposed to high levels of lead in their drinking water, leading to serious environmental and health issues. The problem faced by Flint is a perfect example of the need for a portable device for on-site detection system that can sense the presence of high concentrations of toxic metal ions in the environment in natural pH with no sample pretreatment. In this work, an easy to use method for metal ion detection in natural water samples was developed. Preconcentration of ions at the electrode surface was achieved by optimizing a nanostructured layer consisting of gold nanoparticles and a conductive polymer, which improved detection sensitivity and selectivity withing limits that cover the EPA levels for metal ion exposure. The method was demonstrated for the detection of As, Pb and Hg in natural waters, using anodic stripping voltammetry (ASV). Several parameters were optimized in order to achieve the highest detection sensitivity, including pH, ionic strength and deposition time. Local water samples were tested for heavy metal ion content and validated using lab-based methods, including atomic absorption spectroscopy (AAS) and ICP-MS. This methodology was applied onto the surface of low-cost screen-printed electrodes which are easy to use and portable.

The effect of lead during the Flint water crisis on mouse embryonic stem cells self-renewal and differentiation markers

During the Flint water crisis, the residents of Flint, Michigan experienced a significant increase in blood lead levels. For some this resulted in an increase as high as 40 μg/dL from 5 μg/dL, which is considered to be safe by the Center for Disease Control and Prevention. Since the extent of the effect of the lead exposure in early embryonic development is not greatly investigated, the aim of this study is to explore the effect of lead exposure at concentrations present in Flint, MI during the Flint water crisis in the embryonic development. The expression of pluripotency and self-renewal markers (Oct4, Sox2, Nanog and Zfp-42) coupled with morphological and alkaline phosphatase assays revealed that mouse embryonic stem cells (mESC) pluripotency and self-renewal capabilities are perturbed following exposure in a lead acetate concentration dependent manner. Moreover, mouse embryoid bodies (mEB), which provide ideal models for testing toxicity in vitro, revealed that lead acetate exposure induces fewer but larger mEBs, whereas gene expression analysis of lineage specific transcription factors showed an increased mRNA level of endodermal (Gata 4, Gata 6, Sox 7) and mesodermal markers (Eomes, Hand 1, Slug 1) while the mRNA level of ectodermal markers (Otx 2, Noggin, Sox 1) decreased. Taken all together, these results indicate that lead acetate disturbs the pluripotency of mESC and differentiation potential of mEBs by inhibiting differentiation towards ectodermal lineages and inducing it towards endodermal and mesodermal lineages.

Fruit and Vegetable Prescriptions for Pediatric Patients in Flint, Michigan: Program Development, Methods, and Baseline Characteristics (FS02-05-19)

ObjectivesTo address food access and affordability challenges among low-income children and adolescents, some health care providers are prescribing fresh fruits and vegetables. However, the evaluation of these programs is limited as are descriptions of study designs and needs of the population they serve. Our objectives were to describe the development of a fruit and vegetable prescription program for pediatric patients, baseline characteristics of the study population, child dietary patterns, and household food security. MethodsResearchers partnered with pediatricians in Flint, Michigan to offer one $15 prescription for fresh fruits and vegetables to children at every office visit. Participating vendors included the downtown farmers’ market as well as a local mobile market, which accepts on-line or telephone orders for fruit and vegetable boxes delivered to homes. Following receipt of the prescription, patients (7–18 years of age) were invited to participate in the current study with one caregiver. Researchers restricted enrollment to one child per family. Caregiver-child dyads completed evaluation instruments with a trained research assistant during their pediatric office visit. In addition to completing a demographic survey, caregivers and children responded to questions about dietary patterns, food security, and food access. Results320 caregiver-child dyads enrolled in the study. Most of the children (mean age 12.7 ± 2.9) were African American (68%) and residents of Flint (73%). The majority of caregivers (mean age 39.7 ± 9.7) were female (91%), African American (65%), and receiving SNAP benefits (54%). Of the 277 children who completed the food screener, average intake of vegetables (0.71 cups ± 0.73) and dairy (1.3 cups ± 1.1) as well as whole grains (0.48 ounces ± 0.47) were well below current recommendations. Moreover, nearly half of caregivers who enrolled in the study (47%) reported low or very low household food security. ConclusionsResults confirm and continue to raise deep concerns about dietary behaviors and food insecurity among children in Flint, many of whom continue to face an ongoing drinking water crisis. By addressing both access to fresh produce and food insecurity, the prescription program has the potential to improve fruit and vegetable intake. Funding SourcesThis study was supported by a grant from Michigan Health Endowment Fund.

Moderation of the Association Between Individual Food Security and Poor Mental Health by the Local Food Environment Among Adult Residents of Flint, Michigan.

Purpose: Food insecurity is a psychosocial stressor with deleterious effects on mental health. This study examined whether the local food environment moderates the association of individual food insecurity with poor mental health.Methods: Cross-sectional survey data were collected from adult residents of Flint, Michigan (n=291), in 2015. Multivariate logistic models assessed whether quality of the local food environment moderated the relationship of food insecurity with poor mental health. A binary indicator of poor mental health was created. Participants were asked to rate their overall “mental or emotional health” using a 5-point Likert scale. Individuals were classified as having either good mental health (i.e., ratings of good, very good, or excellent) or poor mental health (i.e., ratings of fair or poor).Results: In fully adjusted models, food insecurity was associated with 3.2 (95% confidence interval [CI]: 1.6–6.2) times higher odds of poor mental health. However, increased proximate access to vegetables and fruits moderated this association. For example, those in the bottom 25th percentile of access to vegetables had 7.4 (95% CI: 2.7–20.5) times higher odds of poor mental health. In contrast, for those in the top 25th percentile of vegetable access, food insecurity was only marginally associated with poor mental health (odds ratio=2.2; 95% CI: 1.0–4.7).Conclusion: Greater proximate access to vegetables and fruits moderated food insecurity's association with poor mental health. Longitudinal evaluation of programs and policies that improve availability of nutrient-rich foods in food insecure communities is needed to determine whether they yield a mental health benefit.

Active and syndromic surveillance for mass gatherings: BOOM festival 2018, Portugal

Purpose: To describe the implementation and results of an active syndromic surveillance team in a planned and recurrent international mass gathering (MG) allowing early detection of outbreaks, and thereby, allowing intervention by local, national and international authorities. Methods & Materials: A field team of 17 health-care workers performed active and syndromic surveillance at Boom Festival 2018 between 21st and 29th of July 2018, in Portugal. Data including demographic characteristics, signs, symptoms, and environmental exposure was collected during admission at Boom Medical Service (BMS). Paper records were transcribed and analyzed with Microsoft Excel® 2016 (v 16.0). Descriptive analysis was performed and reported daily to relevant stakeholders. Results: Approximately 30,000 people from 147 countries attended the BOOM Festival, and 3,100 healthcare episodes occurred, including 451 (14.5%) complaints of gastrointestinal symptoms. During the Festival, there was a considerable increase in the incidence of gastrointestinal symptoms and an early warning alert for a possible outbreak of acute gastroenteritis was issued to the national health authorities on 24th of July. Interventions were carried out in collaboration with local public health authorities to control the outbreak and to address possible common-sources of infection. Contaminated food or water were suspected, and a person-to-person transmission was not excluded since several cases mentioned attending another MG and symptom onset before arrival at the festival. The concern about an early stage outbreak was valid since 62.5% (n = 282) of the cases with gastrointestinal symptoms were reported between 26th-29th of July. Conclusion: Active and syndromic surveillance are essential for timely data collection and analysis in MGs, delivering a comprehensive snapshot of daily incidents, enabling rapid response to possible outbreaks and providing early-warning alerts for stakeholders. Nevertheless, enhancements are needed: data sharing and improved communication channels between stakeholders and similar international MG are necessary to create an effective syndromic surveillance system. Author response to letter from Gomez et al.International Journal of Infectious DiseasesVol. 91PreviewThe abstract by Maki et al. (2019) contained limited information from a poster presented in a late-breaking session at the Seventh International Meeting on Emerging Diseases and Surveillance. The work had IRB approval (HFHS #12383), and informed consent was obtained prior to collecting samples. Full-Text PDF Open AccessBacterial colonization in point-of-use filters and deaths in Flint, MichiganInternational Journal of Infectious DiseasesVol. 91PreviewThe study by Maki et al. (2019) examined the effects of point-of-use (PoU) filters on bacterial infections in residents of Flint, Michigan homes. The authors noted that 12 pathogens (including Pseudomonas aeruginosa) were detected in PoU filters in 10 Flint homes and that residents of 70% of these homes had severe respiratory infections. Additionally alarming, the authors reported an astounding 50% mortality rate in their study sample. Full-Text PDF Open Access

Politically Unhealthy: Flint’s Fight Against Poverty, Environmental Racism, and Dirty Water

The social force of race in relation to natural resources plays a prominent role in which communities are disproportionately affected by pollution. Scholars have described how people of color are disproportionately victims of environmental discrimination and disparities because they lack the necessary social capital to bring attention to their plight, as demonstrated by the case of the Flint, Michigan, Water Crisis. In this article, we use a critical race theory lens to explore how the Flint Water Crisis constitutes a case study of environmental racism. More specifically, we discuss the public health implications of environmental racism on the residents of Flint and conclude with a discussion of the overall implications of environmental justice for public health and social science research.

"I think that's all a lie…I think It's genocide": Applying a Critical Race Praxis to Youth Perceptions of Flint Water Contamination.

In April 2014, the emergency manager of Flint, Michigan switched the city's water supplier from Detroit's water department to the Flint River. The change in water source resulted in the Flint Water Crisis (FWC) in which lead (Pb) from the city's network of old pipes leached into residents' tap water. Residents of Flint reported concerns about the water to officials; however, the concerns were ignored for more than a year. This study sought to understand how Black youth in Flint conceptualize, interpret, and respond to racism they perceive as part of the normal bureaucracy contributing to the FWC. In 2016, we conducted four community forums with Flint youth aged 13 to 17 years. Sixty-eight youth participated with 93% self-identifying as Black. Participants completed a brief survey. We audio-recorded the forums and transcribed them verbatim. Critical Race Theory (CRT) guided the development of the interview protocol and Public Health Critical Race Praxis (PHCRP) served as an interpretive framework during qualitative data analysis. Content analyses were completed using software. Many youth viewed the FWC through a racially conscious frame. They described Flint as a Black city where historical and contemporary forms of racial stratification persist. Some described the contamination of the city's water as a form of genocide targeting Blacks. The findings from this exploratory study suggest some Black youth in Flint have difficulty coping with the FWC. Those who perceive it through a racial frame attribute the crisis to racism. They feel distressed about this and other traumas (eg, failure to address high rates of crime) they perceived as racism-related. Future research should examine the implications for specific mental health outcomes among youth.

Organizing Under Austerity: How Residents’ Concerns Became the Flint Water Crisis

What might it take for politically marginalized residents to challenge cuts in public spending that threaten to harm their health and wellbeing? Specifically, how did residents of Flint, Michigan contribute to the decision of an austerity regime, which was not accountable to them, to spend millions to switch to a safe water source? Relying on evidence from key interviews and newspaper accounts, we examine the influence and limitations of residents and grassroots groups during the 18-month period between April 2014 and October 2015 when the city drew its water from the Flint River. We find that citizen complaints alone were not sufficiently able to convince city officials or national media of widespread illness caused by the water. However, their efforts resulted in partnerships with researchers whose evidence bolstered their claims, thus inspiring a large contribution from a local foundation to support the switch to a clean water source. Thus, before the crisis gained national media attention, and despite significant constraints, residents’ sustained organization—coupled with scientific evidence that credentialed local claims—motivated the return to the Detroit water system. The Flint case suggests that residents seeking redress under severe austerity conditions may require partnerships with external scientific elites.

The effects of the water crisis on population dynamics in the City of Flint, Michigan

ABSTRACTSince 2014, residents of Flint, Michigan have dealt with the effects of lead in their municipal system in a series of events known as the Flint water crisis. While several studies have examined the health effects of the crisis and changes in water lead levels over time, no study has considered whether the crisis has resulted or could result in residents leaving the city. To explore this question, we surveyed 405 Flint residents and used quantitative and qualitative methods, as well as exploratory spatial data analysis, to test five hypotheses about the water crisis and population dynamics. We found that population loss has not yet accelerated, but nearly half of residents are considering leaving. This consideration was true regardless of residents’ demographics or where they lived in the city. We also discovered that perceptions of the water’s safety and its health effects, more than actual water lead levels, predicted whether one is considering leaving. Overall, our results suggest that as water infrastructure quality deteriorates, population loss could accelerate, resulting in a recursive relationship whereby the city’s population and its infrastructure continue to decline.

Pediatric lead exposure and the water crisis in Flint, Michigan.

Changing the source of the water supply to save money had the unintended consequence of exposing residents of Flint, Mich., to elevated lead levels in their drinking water. A study done at Flint's Hurley Children's Hospital demonstrated that the incidence of elevated blood lead levels of children living in the affected area nearly doubled after the change in the water source. This article reviews the recommendations for lead screening and for reporting, following, and treating children with blood lead levels greater than 5 mcg/dL.