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Onookome-Okome T, Hsu A, Kilpatrick DG, Moreland A, Reuben A. Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset. Int J Environ Res Public Health 2023; 20:7090. [PMID: 38063520 PMCID: PMC10706393 DOI: 10.3390/ijerph20237090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
Public works environmental disasters such as the Flint water crisis typically occur in disenfranchised communities with municipal disinvestment and co-occurring risks for poor mental health (poverty, social disconnection). We evaluated the long-term interplay of the crisis and these factors with substance use difficulties five years after the crisis onset. A household probability sample of 1970 adults living in Flint during the crisis was surveyed about their crisis experiences, use of substances since the crisis, and risk/resilience factors, including prior potentially traumatic event exposure and current social support. Analyses were weighted to produce population-representative estimates. Of the survey respondents, 17.0% reported that substance use since the crisis contributed to problems with their home, work, or social lives, including 11.2% who used despite a doctor's warnings that it would harm their health, 12.3% who used while working or going to school, and 10.7% who experienced blackouts after heavy use. A total of 61.6% of respondents reported using alcohol since the crisis, 32.4% using cannabis, and 5.2% using heroin, methamphetamine, or non-prescribed prescription opioids. Respondents who believed that exposure to contaminated water harmed their physical health were more likely to use substances to the detriment of their daily lives (RR = 1.32, 95%CI: 1.03-1.70), as were respondents with prior potentially traumatic exposure (RR = 2.99, 95%CI: 1.90-4.71), low social support (RR = 1.94, 95%CI: 1.41-2.66), and PTSD and depression (RR's of 1.78 and 1.49, respectively, p-values < 0.01). Public works disasters occurring in disenfranchised communities may have complex, long-term associations with substance use difficulties.
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Affiliation(s)
- Tuviere Onookome-Okome
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
- Samuel Centre for Social Connectedness, Montréal, QC H3A 0G4, Canada
| | - Angel Hsu
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Aaron Reuben
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
- Department of Psychology & Neuroscience, Duke University, Durham, NC 27708, USA
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2
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Kilpatrick SK, Bauer KW, Heard-Garris N, Malone AM, Abdou CM, Weeks HM, Clayson M, Allgood KL, Dokshina D, Needham BL. Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity. J Racial Ethn Health Disparities 2023; 10:993-1005. [PMID: 35320509 PMCID: PMC8941828 DOI: 10.1007/s40615-022-01287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/02/2022]
Abstract
We sought to understand how women in Michigan communities outside of Flint experienced the Flint water crisis, an avoidable public health disaster widely attributed to structural racism. Using survey data from 950 Michigan women aged 18-45 from communities outside of Flint, we examined racial and ethnic differences in personal connections to Flint, perceived knowledge about the water crisis, and beliefs about the role of anti-Black racism in the water crisis factors that could contribute to poor health via increased psychological stress. We found that White (OR = 0.32; 95% CI: 0.22, 0.46) and Hispanic (OR = 0.21; 95% CI: 0.09, 0.49) women had lower odds than Black women of having family or friends who lived in Flint during the water crisis. Compared to Black women, White women were less likely to be moderately or very knowledgeable about the water crisis (OR = 0.58; 95% CI: 0.41, 0.80). White women (OR = 0.26; 95% CI: 0.18, 0.37), Hispanic women (OR = 0.38; 95% CI: 0.21, 0.68), and women of other races (OR = 0.28; 95% CI: 0.15, 0.54) were less likely than Black women to agree that the water crisis happened because government officials wanted to hurt Flint residents. Among those who agreed, White women (OR = 0.47; 95% CI: 0.30, 0.74) and women of other races (OR = 0.33; 95% CI: 0.12, 0.90) were less likely than Black women to agree that government officials wanted to hurt people in Flint because most residents are Black. We conclude that the Flint water crisis was a racialized stressor, with potential implications for the health of reproductive-age Black women.
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Affiliation(s)
- Sidonie K. Kilpatrick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Katherine W. Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, and Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 USA
| | - Anita M. Malone
- Division of Women’s Health, Department of Obstetrics and Gynecology, University of Michigan Medical School, Michigan Medicine Health, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Cleopatra M. Abdou
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA 90089 USA
| | - Heidi M. Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Michelle Clayson
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Kristi L. Allgood
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Darya Dokshina
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Belinda L. Needham
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
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Ezell JM, Olson B, Ghosh A, Chase EC. Theorizing on neo public assistance: How do race and class impact resource uptake and behavior following disaster? Soc Sci Med 2022; 314:115464. [PMID: 36327635 DOI: 10.1016/j.socscimed.2022.115464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
The consequences of environmental disasters and other ecologic and communal crises are frequently worst in racially/ethnically minoritized and low-income populations relative to other groups. This disproportionality may create or deepen patterns of governmental distrust and stoke health promotion disengagement in these groups. To date, there has been limited contextualization of how historically disenfranchised populations utilize government-administered or facilitated resources following such disasters. Focusing on the water crisis in Flint, Michigan, we examine and theorize on the usage of neo public assistance, free risk reduction resources that are provided to disaster survivors as a liminal means of redressing ills created and/or insufficiently mitigated by the state. We surveyed 331 Flint residents, evaluating their usage of four neo public assistance resources following the FWC, finding low to moderate uptake: 131 residents (39.6%) indicated that they obtained blood lead level (BLL) screenings, 216 (65.3%) had their tap water tested for lead (Pb) and other contaminants, 137 (41.4%) had their home water infrastructure replaced, and 293 (88.5%) had acquired bottled water at community distribution sites. Unemployment, receiving public benefits, and lacking reliable transportation and stable housing were associated with lower uptake of some resources. Compared to White and "Other" race individuals, Black residents were generally more likely to acquire/utilize these resources, suggesting heightened concerns and health promotion proclivities even in the face of observed macro and individual-level challenges. Potential reasons and implications are discussed.
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Affiliation(s)
- Jerel M Ezell
- General Internal Medicine, Weill Cornell Medicine, New York, NY, USA; Center for Cultural Humility, Cornell University, Ithaca, NY, USA.
| | - Brooke Olson
- General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Arnab Ghosh
- General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth C Chase
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Affiliation(s)
- Siddhartha Roy
- Department of Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061, USA.
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061, USA
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Ezell JM, Chase EC. A Population-Based Assessment of Physical Symptoms and Mental Health Outcomes Among Adults Following the Flint Water Crisis. J Urban Health 2021; 98:642-53. [PMID: 33788147 DOI: 10.1007/s11524-021-00525-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
Little is known about the physical and mental health outcomes of adults in the low-income, predominantly Black city of Flint, Michigan, following the city's water crisis which began in April 2014 after austerity policies led to the city switching its water source. We investigate these dynamics using data from a longitudinal community-based cohort in Flint. Between June and November 2019, surveys were administered at nine public sites across Flint. Nested models were employed to assess relationships between respondent demographics, including race/ethnicity, and self-report of clinician-diagnosed blood lead levels (BLLs) and various physical symptoms and mental health outcomes, including depression/anxiety (PHQ-4) and psychological trauma (PC-PTSD-5). Of the 331 respondents (mean age: 47.9 + 16.5), most were women (58.6%) and Black (57.7%). In total, 10.0% self-reported elevated BLLs, with borderline significantly higher reports among Blacks (p = 0.07). Skin rashes (58.1% vs. 33.9%, p < 0.01), hair loss (45.5% vs. 30.3%, p = 0.01), and nausea (35.6% vs. 20.2%, p = 0.1) were significantly higher among Blacks versus Whites. Additionally, 29.0% and 26.3% of respondents met trauma and depression/anxiety criteria, respectively. Increasing physical symptoms was associated with psychological trauma (OR 2.1, p < 0.01) and depression/anxiety (OR 1.9, p < 0.01). In closing, Flint adults, particularly Blacks, experienced deleterious physical and mental health outcomes following the city's water crisis that appear to represent a substantial burden of excess cases. Further research is needed on how austerity impacts community health in economically distressed urban cities and ways to generate capacity to identify and curb adverse consequences.
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Oshio T, Kupperman J. The Problem Behind the Problem: Applying Human-Centered Design to Child Care in Flint. Early Child Educ J 2021; 50:1373-1382. [PMID: 34566398 PMCID: PMC8451737 DOI: 10.1007/s10643-021-01263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
In response to the water crisis in Flint, Michigan, USA, early childhood education was one of the targets of intervention and prevention for children who were exposed to lead poisoning, because high-quality child care could potentially help improve their developmental trajectories. The Provider Empowerment Program used human-centered design (HCD) to uncover unmet and overlooked needs among child care providers. We discuss the theoretical framework that guided the project and led to a focus on family, friend, and neighbor (FFN) child care providers. We also present three examples of solutions that were uniquely shaped to meet the needs of FFN child care providers in Flint. Each solution was developed by a process that included taking the perspective of the people who faced the problem, spending time to understand the context of the problem, and uncovering the underlying problem which was not apparent at first. Recommendations for use of HCD in community-based problem-solving are discussed.
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Affiliation(s)
- Toko Oshio
- Department of Education, University of Michigan-Flint, 430 French Hall, 303 E. Kearsley, Flint, MI 48502-1950 USA
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Zheng S, Bishop SL, Ceja T, Hanna-Attisha M, LeWinn K. Neurodevelopmental profiles of preschool-age children in Flint, Michigan: a latent profile analysis. J Neurodev Disord 2021; 13:29. [PMID: 34412591 PMCID: PMC8377967 DOI: 10.1186/s11689-021-09377-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 08/03/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Children in Flint, Michigan, have experienced myriad sociodemographic adversities exacerbated by the Flint water crisis. To help inform child-focused prevention and intervention efforts, we aimed to describe patterns of neurodevelopmental outcomes among preschoolers who experienced the Flint water crisis before age 2 years. METHOD Participants were 170 preschoolers who completed a comprehensive neurodevelopmental assessment battery, including directly administered measures of cognitive and executive functioning and maternal-report of adaptive skills and behavioral problems. We used latent profile analysis to derive subgroups. Multivariate multinomial logistic regression was conducted to examine the predictors of profile memberships, including child sex and maternal/family-level factors selected from an array of measured exposures using least absolute shrinkage and selection operator regression. RESULTS Three latent profiles were identified: Profile 1-relative weakness in all domains (50%); Profile 2-normative functioning in all domains (34.1%); and Profile 3-relative strengths in executive function and behavior (15.9%). Profile 1 showed lower scores across cognitive and behavioral domains. Profile 2 demonstrated abilities within the normal range across domains. Profile 3 showed relative strength in executive functioning with few behavior problems, despite lower cognitive performance. Children across all profiles showed adaptive behavior in the adequate range. Child sex and maternal IQ were significant predictors of profile membership. CONCLUSIONS Children in Flint demonstrated diverse patterns of development in the face of sociodemographic and environmental adversities. Comprehensive screening and neurodevelopmental profiling of children in this at-risk population are needed to identify areas of needs and inform appropriate service delivery.
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Affiliation(s)
- Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Tiffany Ceja
- Division of Public Health, Pediatric Public Health Initiative, Michigan State University, Flint, MI, 48502, USA
| | - Mona Hanna-Attisha
- Division of Public Health, Pediatric Public Health Initiative, Michigan State University, Flint, MI, 48502, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, 48824, USA
| | - Kaja LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
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8
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Roy S, Mosteller K, Mosteller M, Webber K, Webber V, Webber S, Reid L, Walters L, Edwards MA. Citizen science chlorine surveillance during the Flint, Michigan federal water emergency. Water Res 2021; 201:117304. [PMID: 34107367 DOI: 10.1016/j.watres.2021.117304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 05/12/2023]
Abstract
Rising incidence of waterborne diseases including Legionellosis linked to low chlorine residuals in buildings and the availability of inexpensive testing options, create an opportunity for citizen science chorine monitoring to complement sampling done by water utilities. University researchers and Flint residents coordinated a citizen science chlorine surveillance campaign in Flint, Michigan in 2015-19, that helped expose the nature of two deadly Legionnaires Disease outbreaks in 2014-2015 during the Flint Water Crisis and progress of system recovery during the Federal emergency. Results obtained with an inexpensive color wheel were in agreement with a digital colorimeter (R2 =0.99; p = 2.81 × 10-21) at 15 sites geographically distributed across Flint. Blinded tests revealed good agreement between official (n = 2051) and citizen (n = 654) data in terms of determining whether regulatory guidelines for chlorine were met, but a discovery that the citizen data were statistically lower than the city's (p<0.00001) especially in warm summer months led to recommendations for increased flushing of service lines before measurements. This work suggests that expanded citizen surveillance of chlorine, site specific flushing advice, and guidance on decisions about water heater set point could help consumers reduce Legionella risks in their homes. Citizen science initiatives for chlorine monitoring offer a unique opportunity for mutually beneficial collaborations between consumers and utilities to reduce the main source of waterborne disease in developed countries.
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Affiliation(s)
- Siddhartha Roy
- Civil and Environmental Engineering, Virginia Tech, USA.
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Davis KM. Lead Poisoning Prevention Efforts in High-Risk Environments: Follow-up Testing Rates among Preschool Children in Flint, Michigan, 2013-2015. J Racial Ethn Health Disparities 2020; 8:199-209. [PMID: 32514782 DOI: 10.1007/s40615-020-00772-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite the importance of screening in efforts to address lead poisoning, many children in the United States have never been tested for lead, even when required to receive blood lead testing by state and federal healthcare policy. Fewer children gain access to follow-up or confirmatory testing when elevated blood lead levels are detected. METHODS In response to previous research that illustrates the extent to which follow-up treatment services have been underutilized and poorly coordinated, this retrospective cohort study examines follow-up testing trends for lead poisoning among Medicaid-enrolled children 6 years and younger in Flint, Michigan, between 2013 and 2015. RESULTS These findings illustrate that compliance with follow-up testing procedures was less than adequate during the period of study. CONCLUSION As illustrated in this bivariate analysis, subpopulations in Flint most likely to have lead poisoning were least likely to receive follow-up testing. Evidence also demonstrates that the likelihood that children with lead poisoning received follow-up testing was overwhelmingly associated with their blood lead concentration level than other indicators including socioeconomic status in this high-risk environment.
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Affiliation(s)
- Katrinell M Davis
- Department of Sociology, Florida State University, 526 Bellamy Building, 113 Collegiate Loop, PO Box 3062270, Tallahassee, FL, 32306-2270, USA.
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10
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Abokifa AA, Katz L, Sela L. Spatiotemporal trends of recovery from lead contamination in Flint, MI as revealed by crowdsourced water sampling. Water Res 2020; 171:115442. [PMID: 31927093 DOI: 10.1016/j.watres.2019.115442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
In the aftermath of the lead contamination crisis that plagued the water system in Flint, MI, more than 35,000 water samples were collected from the city's premises. The majority of these samples (>85%) were collected through a voluntary crowdsourced sampling campaign. The samples were analyzed for lead and copper concentrations by the Michigan Department of Environmental Quality (MDEQ). In this study, the crowdsourced sampling data was analyzed by means of spatial autocorrelation analysis to reveal the locations of statistically significant hotspot regions of high water lead levels (WLLs), and to track the spatiotemporal evolution of WLLs as the system recovered from lead contamination. The results showed that hotspot regions that experienced high WLLs were consistent with the areas where lead service line (LSL) density was the highest. Additionally, galvanized service lines and other lead-containing plumbing components could have also contributed to lead release in hotspot regions. The temporal trend exhibited by the crowdsourced sampling data did not reflect a consistent decrease in WLLs despite the interventions implemented by MDEQ and EPA. Instead, sampled WLLs remained high for several months after boosting the orthophosphate dose and launching a city-wide residential flushing campaign. The findings of this study suggest that this could be partially attributed to disproportionate sampling from premises in hotspot regions of high WLLs and LSL density.
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Affiliation(s)
- Ahmed A Abokifa
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, 10100 Burnet Rd, MC R8000, Austin, TX, 78750, USA.
| | - Lynn Katz
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, 10100 Burnet Rd, MC R8000, Austin, TX, 78750, USA
| | - Lina Sela
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, 10100 Burnet Rd, MC R8000, Austin, TX, 78750, USA
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11
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Zahran S, Mushinski D, McElmurry SP, Keyes C. Water lead exposure risk in Flint, Michigan after switchback in water source: Implications for lead service line replacement policy. Environ Res 2020; 181:108928. [PMID: 31787215 PMCID: PMC7096221 DOI: 10.1016/j.envres.2019.108928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/13/2019] [Accepted: 11/14/2019] [Indexed: 05/27/2023]
Abstract
In February of 2016, the City of Flint, Michigan commenced the FAST start initiative with the aim "to get the lead out of Flint" by replacing lead and galvanized steel service lines throughout the city. An estimated 29,100 parcels are scheduled for service line replacement (SLR) at an expected cost of $172 million. The lead exposure benefits of SLR are evaluated by analyzing Sentinel data on hundreds of repeatedly sampled homes in Flint from February 16, 2016 to July 21, 2017, comparing water lead (WL) in homes with and without lead service lines. Samples taken from homes with lead service lines were significantly more likely to exceed specified thresholds of WL than homes without lead service lines. Second, regardless of service line material type, sampled homes experienced significant reductions in WL with elapsed time from Flint's switchback to water provided by the Detroit Water and Sewage Department. Third, the risk of exceedance of WL > 15 μg/L was uncorrelated with service line material type. These results are robust to sample restrictions, period stratification, time operations, reference group definitions, and statistical modeling procedures. On the question of what is gained from SLR over optimal corrosion control techniques, we simulated age-specific lead uptake (μg/day) and blood lead levels (μg/dL) for children in Flint at 16 and 90 weeks of elapsed time from Flint's switchback to Detroit water. At 90 weeks from the switchback in water source, the quantity of water lead consumed by children in homes with lead service lines decreased 93%, as compared to 16 weeks. Lead exposure benefits of SLR have declined in time, with modest differences in lead uptake across homes with different service lines. In light of results, policy considerations for Flint and nationwide are discussed.
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Affiliation(s)
- Sammy Zahran
- Department of Economics, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, Fort Collins, CO, USA.
| | - David Mushinski
- Department of Economics, Colorado State University, Fort Collins, CO, USA
| | - Shawn P McElmurry
- Department of Civil & Environmental Engineering, Wayne State University, Detroit, MI, USA
| | - Christopher Keyes
- Department of Economics, Colorado State University, Fort Collins, CO, USA
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12
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Monear NC, Xhabija B. The effect of lead during the Flint water crisis on mouse embryonic stem cells self-renewal and differentiation markers. Toxicol In Vitro 2019; 63:104719. [PMID: 31715224 DOI: 10.1016/j.tiv.2019.104719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/05/2019] [Accepted: 11/07/2019] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Nicodemus C Monear
- Department of Chemistry and Biochemistry, University of Michigan- Flint, Flint, MI 48502, United States of America
| | - Besa Xhabija
- Department of Chemistry and Biochemistry, University of Michigan- Flint, Flint, MI 48502, United States of America.
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13
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Roy S, Tang M, Edwards MA. Lead release to potable water during the Flint, Michigan water crisis as revealed by routine biosolids monitoring data. Water Res 2019; 160:475-483. [PMID: 31177077 DOI: 10.1016/j.watres.2019.05.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 06/09/2023]
Abstract
Routine biosolids monitoring data provides an independent and comprehensive means to estimate water lead release pre-, during and post-Flint Water Crisis (FWC). The mass of potable plumbing-related metals (i.e., lead, cadmium, copper, nickel and zinc) in sewage biosolids strongly correlated with one another during the FWC (p < 0.05). A simple parametric regression model based on 90th percentile potable water lead measurements (WLL90) from five city-wide citizen science sampling efforts August 2015-August 2017 was strongly correlated to corresponding monthly lead mass in biosolids [Biosolids-Pb (kg) = 0.483 x WLL90 (μg/L) + 1.79; R2 = 0.86, p < 0.05]. Although total biosolids lead increased just 14% during the 18 months of the FWC versus the comparable time pre-FWC, 76% of that increase occurred in July-September 2014, and the corresponding percentage of Flint children under 6 years with elevated blood lead ≥ 5 μg/dL (i.e., %EBL5) doubling from 3.45% to 6.61% in those same three months versus 2013 (p < 0.05). %EBL5 was not statistically higher during the remaining months of the FWC compared to pre-FWC or post-FWC. As expected, lead in biosolids during the FWC, when orthophosphate was not added, was moderately correlated with water temperature (R2 = 0.30, p < 0.05), but not at other times pre- and post-FWC when orthophosphate was present. Tripling the orthophosphate dose post-FWC versus pre-FWC and some lead pipe removal, decreased lead in biosolids (and %EBL5) to historic lows (2016-2017 vs. 2012-2013; p < 0.05), supporting the effectiveness of these public health interventions in reducing childhood water lead exposure.
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Affiliation(s)
- Siddhartha Roy
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA, 24061, USA.
| | - Min Tang
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA, 24061, USA
| | - Marc A Edwards
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA, 24061, USA
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Gómez HF, Borgialli DA, Sharman M, Shah KK, Scolpino AJ, Oleske JM, Bogden JD. Analysis of blood lead levels of young children in Flint, Michigan before and during the 18-month switch to Flint River water. Clin Toxicol (Phila) 2019; 57:790-797. [PMID: 30871386 DOI: 10.1080/15563650.2018.1552003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The toxicity of lead, like any xenobiotic, is directly linked to the duration of exposure and toxin concentration in the body. The elevation in blood lead levels (BLLs) in young Flint, Michigan children noted in time-periods before, and during the 18-month exposure to Flint River water (FRW) from 25 April 2014 to 15 October 2015 is well-known internationally. The length of time BLLs were elevated is unknown, yet key in understanding the potential health impact of the event. The objective of this study was to evaluate whether BLLs in Flint children were increased during the entire 18-month FRW exposure compared to similar earlier time periods. Methods: We conducted a retrospective study analyzing BLLs from Flint children aged 5 years and under. The geometric mean (GM) BLLs and percentages of BLLs ≥5.0 μg/dL in Period I: 25 April 2006 to 15 October 2007 (earliest timeframe available for study) and Period II: 25 April 2012 to 15 October 2013 (timeframe immediately before the water switch), were compared to Period III, 25 April 2014 to 15 October 2015 (FRW exposure). Results: There were 5663 BLLs available for study. GM ± SE BLLs decreased from 2.19 ± 0.03 μg/dL in Period I to 1.47 ± 0.02 μg/dL in Period II [95% CI, 0.64, 0.79]; p<.001 and decreased further to 1.32 ± 0.02 µg/dL during the FRW Period III [95% CI, 0.79, 0.95]; p<.001. The percentage of BLLs ≥5.0 μg/dL decreased from Period I (10.6%) to Period II (3.3%) [95% CI, 5.7, 8.8]; p<.001 and from Period I to Period III (3.9%) [95% CI, 5.0, 8.2]; p=.002. The 0.6% increase from Period II to Period III was not statistically significant [95% CI, -1.9, 0.57]; p=.30. Conclusion: Analyses of GM and percentages ≥5.0 μg/dL of BLLs do not support the occurrence of a global increase in BLLs in young children of Flint during the entire 18-month period of FRW exposure.
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Affiliation(s)
- Hernán F Gómez
- a Department of Emergency Medicine, University of Michigan , Ann Arbor , MI , USA.,b Department of Emergency Medicine, Hurley Medical Center , Flint , MI , USA
| | - Dominic A Borgialli
- a Department of Emergency Medicine, University of Michigan , Ann Arbor , MI , USA.,b Department of Emergency Medicine, Hurley Medical Center , Flint , MI , USA
| | - Mahesh Sharman
- c Department of Pediatrics, Michigan State University College of Human Medicine, Hurley Medical Center , Flint , MI , USA
| | - Keneil K Shah
- d Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Anthony J Scolpino
- e Department of Pediatrics, Rutgers New Jersey Medical School , Newark , NJ , USA
| | - James M Oleske
- e Department of Pediatrics, Rutgers New Jersey Medical School , Newark , NJ , USA
| | - John D Bogden
- f Department of Microbiology, Biochemistry, and Molecular Genetics, Rutgers New Jersey Medical School , Newark , NJ , USA
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Craft-Blacksheare M. The Growing Impact of Legionella in the Flint Water Crisis. J Natl Black Nurses Assoc 2018; 29:44-50. [PMID: 30282132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The water crisis in Flint, Michigan raised national awareness about lead- tainted drinking water, particularly its harm to children and pregnant and lactating women. However, according to recent findings, there may be another by-product of this man-made crisis. Failure to use anticorrosive material in the water, a practice mandated by the 1978 Clean Water Act, is being linked to an outbreak of Legionnaires' disease, an illness detrimental primarily to adults over 65 years of age. While Legionnaires' disease is relatively rare, it is also likely to remain undiagnosed. Clinicians, therefore, are urged to consider this diagnosis in adults with pneumonia that does not respond to typical antibiotic treatment, and in newborns with respiratory distress along with other non-typical symptoms as well as those who have had water births or who were exposed to ultrasonic, cool-mist humidification.
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Affiliation(s)
- Melva Craft-Blacksheare
- University of Michigan-Flint School of Nursing, 2180 William S. White Building, 303 E. Kearsley Street, Flint, MI 48502- 1950.
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16
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Byrne BG, McColm S, McElmurry SP, Kilgore PE, Sobeck J, Sadler R, Love NG, Swanson MS. Prevalence of Infection-Competent Serogroup 6 Legionella pneumophila within Premise Plumbing in Southeast Michigan. mBio 2018; 9:e00016-18. [PMID: 29437918 DOI: 10.1128/mBio.00016-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coinciding with major changes to its municipal water system, Flint, MI, endured Legionnaires’ disease outbreaks in 2014 and 2015. By sampling premise plumbing in Flint in the fall of 2016, we found that 12% of homes harbored legionellae, a frequency similar to that in residences in neighboring areas. To evaluate the genetic diversity of Legionella pneumophila in Southeast Michigan, we determined the sequence type (ST) and serogroup (SG) of the 18 residential isolates from Flint and Detroit, MI, and the 33 clinical isolates submitted by hospitals in three area counties in 2013 to 2016. Common to one environmental and four clinical samples were strains of L. pneumophila SG1 and ST1, the most prevalent ST worldwide. Among the Flint premise plumbing isolates, 14 of 16 strains were of ST367 and ST461, two closely related SG6 strain types isolated previously from patients and corresponding environmental samples. Each of the representative SG1 clinical strains and SG6 environmental isolates from Southeast Michigan infected and survived within macrophage cultures at least as well as a virulent laboratory strain, as judged by microscopy and by enumerating CFU. Likewise, 72 h after infection, the yield of viable-cell counts increased >100-fold for each of the representative SG1 clinical isolates, Flint premise plumbing SG6 ST367 and -461 isolates, and two Detroit residential isolates. We verified by immunostaining that SG1-specific antibody does not cross-react with the SG6 L. pneumophila environmental strains. Because the widely used urinary antigen diagnostic test does not readily detect non-SG1 L. pneumophila, Legionnaires’ disease caused by SG6 L. pneumophila is likely underreported worldwide. L. pneumophila is the leading cause of disease outbreaks associated with drinking water in the United States. Compared to what is known of the established risks of colonization within hospitals and hotels, relatively little is known about residential exposure to L. pneumophila. One year after two outbreaks of Legionnaires’ disease in Genesee County, MI, that coincided with damage to the Flint municipal water system, our multidisciplinary team launched an environmental surveillance and laboratory research campaign aimed at informing risk management strategies to provide safe public water supplies. The most prevalent L. pneumophila strains isolated from residential plumbing were closely related strains of SG6. In laboratory tests of virulence, the SG6 environmental isolates resembled SG1 clinical strains, yet they are not readily detected by the common diagnostic urinary antigen test, which is specific for SG1. Therefore, our study complements the existing epidemiological literature indicating that Legionnaires’ disease due to non-SG1 strains is underreported around the globe.
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Abstract
We describe the self-reported socioeconomic and health impacts, as well as the coping mechanisms employed by a drug-using cohort of adults during the Flint water crisis (FWC) in Flint, Michigan. Participants from an ongoing longitudinal Emergency Department study were contacted between April 2016 and July 2016 and completed a survey focusing on exposure, consequences, and coping strategies. One hundred thirty-three participants (mean age = 26, 65% African-American, 61% public assistance) completed the survey (37.9% response rate). Of these, 75% reported exposure to water with elevated lead levels. Of these, 75% reported additional monthly expenses resulting from exposure. Almost 40% of parents reported changes in their children's health and 65% reported changes to their health since the FWC. Participants indicated the use of both positive (e.g., advice from trusted neighbors, 99.0%) and negative coping mechanisms (e.g., increased substance use, 20.0%) in response to this public health emergency. High-risk Flint residents reported multiple social, economic, and health-related consequences stemming from the FWC. Policymakers should consider additional resources for those affected, including increased access to mental health to aid recovery within the community.
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Affiliation(s)
- Nia Jeneé Heard-Garris
- The Robert Wood Johnson Foundation Clinical Scholars Program at the University of Michigan Medical School, North Campus Research Complex 2800 Plymouth Road Building 10, Room G016, Ann Arbor, 48109, MI, USA.
| | - Jessica Roche
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
| | - Patrick Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA
| | - Maureen Walton
- University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, 48109, MI, USA
| | - Marc Zimmerman
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, 48109, MI, USA
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
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Campbell C, Greenberg R, Mankikar D, Ross RD. A Case Study of Environmental Injustice: The Failure in Flint. Int J Environ Res Public Health 2016; 13:ijerph13100951. [PMID: 27690065 PMCID: PMC5086690 DOI: 10.3390/ijerph13100951] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
The failure by the city of Flint, Michigan to properly treat its municipal water system after a change in the source of water, has resulted in elevated lead levels in the city’s water and an increase in city children’s blood lead levels. Lead exposure in young children can lead to decrements in intelligence, development, behavior, attention and other neurological functions. This lack of ability to provide safe drinking water represents a failure to protect the public’s health at various governmental levels. This article describes how the tragedy happened, how low-income and minority populations are at particularly high risk for lead exposure and environmental injustice, and ways that we can move forward to prevent childhood lead exposure and lead poisoning, as well as prevent future Flint-like exposure events from occurring. Control of the manufacture and use of toxic chemicals to prevent adverse exposure to these substances is also discussed. Environmental injustice occurred throughout the Flint water contamination incident and there are lessons we can all learn from this debacle to move forward in promoting environmental justice.
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Affiliation(s)
- Carla Campbell
- Department of Public Health Sciences, Room 408, College of Health Sciences, University of Texas at El Paso, 500 W. University Ave, El Paso, TX 79968, USA.
| | - Rachael Greenberg
- National Nurse-led Care Consortium (NNCC), Philadelphia, PA 19102, USA.
| | - Deepa Mankikar
- Research and Evaluation Group, Public Health Management Corporation, Philadelphia, PA 19102, USA.
| | - Ronald D Ross
- Occupational and Environmental Medicine Consultant, Las Cruces, NM 88001, USA.
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