Research

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Description:
The Flint Water Crisis has devastated the City of Flint and its residents in profound ways. The residents were provided municipal water that ranged from unsafe to toxic. Residents have been dealing with a wide range of psycho-social and health consequences that include 1) government mistrust (including valid experiences of being marginalized by structural racism and classism), 2) trauma-related responses, 3) water-related illness and injury (e.g., elevated lead exposure and water-borne illness such as Legionnaires disease, and dermal reactions), and 4) inevitable long-term consequences of exposure to lead among infants, children, and youth, including predictable deficits in executive functioning and cognitive ability, poor educational and occupational outcomes, increased impulsivity and violent behavior, increased risk of substance use, and poor decision-making later in life. The breakdown caused by the Flint Water Crisis is a function of and exacerbated by a broken infrastructure in both the built environment and state and local government. Flint has major structural issues related to food access, transportation and a fragile public health and educational system that has been further weakened by major funding cuts and budgetary mismanagement. Although these challenges are not unique to Flint, they do provide an opportunity to study the long-term impacts of lead and other structural risk factors on the health of residents as well as estimate the impact of interventions. Given that the impacts of this man-made disaster on the health of the Flint community are broad-based and long lasting, public health approaches to understanding and intervening should be as well. The expressed concerns go far beyond the impact of this exposure on children, yet funding and other resources that have come to the Flint community have been largely focused on the health impact of lead exposure on young children. The FASt will employ a multi-generational and inter-generational approach to assessing current lead exposure of all those affected, including children, adolescents, adults, and older adults. We will use a life course approach to assess the medical, psycho-social, developmental, and economic impact on those affected across the life span. This will be a longitudinal cohort study following the exposed population over an indefinite period of time as well as their offspring to better understand the inter-generational transmission of risk and resilience. The proposed study builds upon the strengths of a seminal study, the Framingham Heart Study, and also fills some major gaps in our current understanding about how risk and resilience are transmitted in vulnerable populations.
Project Principal Investigator:
Debra Furr-Holden
Project Principal Investigator:
Richard Sadler
Lead Institution:
Michigan State University College of Human Medicine Division of Public Health
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Description:
Diabetes is a health epidemic that affects 29 million Americans. In 2013, 12.2% (95%CI: 10.7% to 13.5%) of those living in Genesee County, or over 37,000 people, reported having been diagnosed with diabetes.1 Type 2 diabetes accounts for up to 95% of all diagnosed cases of diabetes and is the leading cause of kidney failure, lower limb amputations and adult blindness2. These complications of diabetes can be mitigated with improved adherence to glycemic control measures. The goal of the Diabetes Education Program is to engage senior residents with type 2 diabetes in the Flint community in the learning process about diabetes management in an effort to decrease diabetes complications and related conditions while also providing an exceptional learning opportunity for students enrolled in the health care professions. The program will include education related to diabetes care and incorporating exercise into the management of diabetes. This feasibility project will provide evidence that will guide the inclusion of interprofessional diabetes educational training and participation in the various curriculums. Sustainability of this program is a committed goal of both the academic (UM-Flint’s Departments of Physical Therapy and Public Health and Health Sciences and the School of Nurisng) and community partners (McFarlan Villages). Lastly, this feasibility project will teach students how to work collaboratively with at risk populations. People with diabetes are at risk of developing serious complications when diabetes is poorly controlled.
Project Principal Investigator:
Suzanne Trojanowski
Lead Institution:
University of Michigan Flint
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Description:
This proposal is in response to a request by MEDC’s senior leadership to conduct a rigorous, objective evaluation of the Community Ventures initiative. CV represents an innovative approach to connecting structurally unemployed people to long-term employment. Its key innovations are: partnering with potential employers and entrepreneurs to specify workforce needs; working with local workforce agencies to identify potential employees; tailoring worker training to better match employers’ needs and workers’ skills; sharing the costs of training and supporting participating workers; and funding wrap-around services to assist with job retention. If successful, CV can serve as a new model for creating opportunities and reducing unemployment amongst an especially vulnerable and difficult-to-employ segment of the workforce in the state’s most challenged communities. Community Ventures’ program documents describe several short-term and long-term goals. The short-term goal is to connect 1,000 structurally unemployed residents of Detroit, Pontiac, Flint and Saginaw with long-term employment by the end of FY 2012-13. Long-term goals include transforming communities, reducing crime, enhancing economic opportunity, and alleviating poverty. Given the nine-month timeline for this evaluation, it will not be possible to thoroughly assess progress on all of the long-term goals. The evaluation will instead focus primarily on the short-term goal of connecting structurally unemployed people to stable employment.
Project Principal Investigator:
Elisabeth Gerber
Lead Institution:
University of Michigan Gerald R. Ford School of Public Policy
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Description:
Implementing to sustain: Determining the minimum necessary intervention to maintain a postpartum depression prevention program (ROSE) in clinics providing prenatal services to low-income women. ROSE is a group intervention to prevent postpartum depression (PPD), delivered during pregnancy. ROSE has been found to reduce cases of PPD in multiple randomized trials in community prenatal settings with racially and ethnically diverse low-income pregnant women. Given the need for return on investment studies about sustainment efforts, we propose a Sequential Multiple Assignment Randomized (SMART) Trial of the effectiveness and cost-effectiveness of a stepwise approach to sustainment of ROSE in 90 outpatient clinics providing prenatal care to pregnant women on public assistance in 6 U.S. states (including sites in Flint and elsewhere in Michigan).
Project Principal Investigator:
Jennifer Johnson
Project Principal Investigator:
Caron Zlotnick
Lead Institution:
Michigan State University
Project Type:
Description:
UM-Flint graduate student will develop explicit research prospectus on assessing disease transmission and risk, visit rooting sites for damage assessments, and participate in implementation of swine control. The student will assist in the collection and analysis of disease data. Ultimately, the student will produce and finalize a thesis. In conjunction with project collaborators, UM-Flint will provide support for swine trapping, radio-collaring, and culling activities.
Project Principal Investigator:
Karmen Hollis-Etter
Lead Institution:
University of Michigan Flint Provost
Project Type:
Description:
An emerging public health problem is the recent rise in prescription drug misuse (PDM; i.e., non-medical use-without a prescription and medical misuse – with a prescription but in a manner not intended by the prescriber), with school based samples showing one in four teens report taking a prescription drug without a doctor?s prescription. PDM is most common among youth using other substances, with marijuana being the most commonly used illicit drug used by adolescents. PDM is particularly concerning given recent rises in overdose and marijuana use among adolescents is related to numerous negative health and social consequences including low academic achievement, injury, risk for developing substance abuse, and sexual risk-taking. Primary care represents an underutilized setting for understanding PDM among adolescents, particularly because it is a common location for receipt of such prescriptions, and prior medical use of prescription drugs is a risk factor for later PDM. This study will take place in federally-qualified community health clinics located in Flint, Michigan, serving a diverse population of medically underserved youth. Significant limitations of prior work on PDM among adolescents are: (1) the lack of data regarding longitudinal trajectories of use among those who have already initiated PDM, to examine escalation in use as well as other health and social outcomes, as well as those who have not initiated use, to examine initiation of PDM; and (2) the lack of data regarding screening for PDM among adolescents in primary care. The first aim of this study is to conduct secondary data analyses to examine one year trajectories of initiation and escalation of PDM among adolescents who took part in a randomized controlled trial of a brief intervention in primary care. We expect that predictors of initiation and escalation of PDM will include: (a) demographic factors (gender, race, age); and (b) individual (i.e., substance use, delinquency), peer (i.e., substance use), and parent (i.e., approval of drug use) influences. The second aim of this study is to conduct a pilot study in primary care to examine variation in rates of PDM as determined by existing screening measures and diversion. The proposed research is significant because there is an urgent need to understand PDM among adolescents in urban primary care settings serving underserved youth, who are a particularly at-risk population and innovative by capitalizing on an existing dataset to examine longitudinal trajectories as well as use computerized screening to examine rates and correlates of PDM among youth in underserved areas.
Project Principal Investigator:
Frederic Blow
Lead Institution:
University of Michigan Medical School
Project Type:
Description:
The Flint Adolescent Study (FAS) is a longitudinal study conducted by the Prevention Research Center (PRC) at the University of Michigan School of Public Health. The study began in 1994 with a cohort of 9th graders in the Flint, MI area. Individuals were interviewed every year between 1994-1997, 1999-2003, and 2008-2012. The original goal of the study was to explore the protective factors associated with school dropout and ATOD use across their four high school years. In 2013 the PRC-UM received funding to initiate a fourth round of interviewing with a sub-sample of the original sample. Eligible cohort members will include those with one or more children between the ages of 5-16. The current longitudinal study takes advantage of the resulting rich dataset that includes individual (e.g., ATOD use) and family (e.g., parental support) characteristics over time and neighborhood level variables (e.g., census tract, police incident data, community survey data) to contribute to our knowledge about intergenerational transmission of ATOD risk and behavior. Our Specific Aims are to: (1) examine how individual and family factors measured across adolescence and young adulthood predict G1’s parenting attitudes and behaviors; (2) identify which G1 parenting attitudes and behaviors predict G2 ATOD use antecedents (both risk and promotive factors) and subsequent ATOD use (or nonuse); (3) test a social ecological model that incorporates the findings from Aims 1-2 into a comprehensive model testing both longitudinal influences and structural paths; and (4) determine the extent to which Aims 1-2 are influenced by neighborhood characteristics. The goal of the summer research project is to introduce the FAS study to the selected intern. The intern will be provided with opportunities to colaborate with the resarch team on different research activities, including familiarizing with literature on the realted topics, conducting basic data analysis tasks, exploring research questions, and attending project meetings.
Project Principal Investigator:
Marc Zimmerman
Lead Institution:
University of Michigan School of Public Health
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Description:
Existing studies have major methodological issues that have hindered our ability to develop a useful guideline for effective applications of alternative measurements for daily patterns of drug use and related risk behaviors in a variety of research and clinical settings. The long-term goal of this project is to extract crucial information from daily process data of health risk behaviors to inform prevention and intervention. The objective in this particular application is to develop cost-effective measurement and cutting-edge methodology to collect and analyze daily process data. To accomplish this objective, two specific aims will be pursued: 1) Develop cutting-edge statistical methodology to address the missing data issue of prospective measurements including the interactive voice response (IVR) system and text-messaging (TM) and to examine reactivity and validity based on daily patterns of health risk behaviors (drug/alcohol use, violence, and HIV risk sexual behavior); and 2) Conduct an experimental study using a high risk sample from the Flint Youth Injury (FYI) study with a novel design to evaluate compliance, reactivity and validity under different measurements and assessment schedules. Under the first aim, new statistical methodology with free software will be developed based on the data features of the FYI study that has conducted 5 wave assessments on drug related behaviors among at-risk adolescents and young adults. Under the second aim, we will randomize the FYI participants to 5 conditions: (1) daily TM, (2) weekly TM, (3) daily IVR, (4) weekly IVR, and (5) control. The retrospective measurement, timeline follow back (TLFB), and outcome assessment will be administered to all groups for validity evaluation. The weekly protocol is hypothesized to promote compliance due to a lighter participant burden and to prevent reactivity due to a lower dose of self-monitoring; the TM is hypothesized to be more favorable among adolescents or young adults and thus may promote compliance and even reactivity. The new methodology developed in Specific Aim 1 will be used to analyze the data collected in Specific Aim 2. The approach is innovative because the new methodology coupled with the unique study design will resolve current methodological issues. In addition, the methodology developed according to the features of longitudinal data from the high risk youth sample with 63% African-Americans will be highly applicable for statistical analysis for prevention and intervention purposes. The 9 waves data collected through this proposed project and prior funding will also provide an invaluable opportunity to build developmental models for disadvantaged at-risk youth. The proposed research is significant because this is the first study that compares the IVR and TM for measuring daily patterns of multiple risk behaviors in terms of compliance, reactivity, construct validity, and predictive validity. The finding of this study can inform prevention scientists and clinicians about effective applications of the new technology to assess risk for long-term health problems, develop screening protocols, design intervention facilitating behavioral changes, and evaluate intervention effects longitudinally.
Project Principal Investigator:
Rebecca Cunningham
Lead Institution:
University of Michigan Medical School
Project Type:
Description:
Violent crime is a persistent problem in Flint, Michigan, which far surpasses MI and national rates for murder, rape, robbery, and aggravated assaults (FBI, 2012). Although Flint faces economic and social challenges, the city also benefits from assets that provide a firm foundation for community change. We propose to examine the effects of crime prevention through environmental design (CPTED) on youth violence in a selected area of Flint: the University Avenue Corridor (UAC). A coalition of community organizations, the University Avenue Corridor Coalition (UACC), formed in 2012 with a mission to implement CPTED activities to address blight and crime hotspots, improve neighborhood health and safety, stabilize land use, establish leisure and recreational areas, and create and improve communication links and education in the area. Members – including universities, neighborhood groups, health and social services organizations, local businesses, charitable groups, fraternal organizations, and law enforcement – agreed to offer their resources to address critical issues facing the area and support one another’s initiatives. The proposed evaluation design capitalizes on an overlap between the UAC and intervention area of the Michigan Youth Violence Prevention Center?s (MI-YVPC). The MI-YVPC supports six programs in a 2.3 square mile area of Flint and has monitored a comparison area 1.6 miles from the YVPC/UAC intervention areas. Crime, injury, and property assessment data collected by MI-YVPC allow us to establish a baseline for these indicators prior to the initiation of the UACC in 2012, and during the proposed project. We will conduct an outcome evaluation of the entire UACC effort utilizing a 2X2 design. The outcome evaluation will employ a quasi-experimental design to assess the effectiveness of four conditions: CPTED only, CPTED plus MI-YVPC interventions, MI-YVPC interventions only, and a comparison area where neither intervention was implemented. We will compare neighborhoods that did not receive the interventions in two ways: 1) comparative analysis across neighborhoods with similar violence incidence and demographic characteristics; and 2) spatial analysis comparing outcomes across all census tracts controlling for several confounding variables. The study outcomes will include crime incidents, assault injuries, property conditions, and resident perceptions and behaviors. We will draw upon the expertise and data resources of the MI-YVPC to carry out a study that compares various types and intensities of violence prevention interventions. Our collaboration with the UACC both provides useful input for interpreting evaluation results, and ensures sustainability and scalability of the program after our evaluation is completed.
Project Principal Investigator:
Marc Zimmerman
Lead Institution:
University of Michigan School of Public Health
Project Type:
Description:
Proposed Tasks and Deliverables Explanation Task 1 The GISC proposes that Task 1 be completed as soon as possible. The results from the GIS Needs Study will drive the other two tasks and the successful completion of those tasks. The GIS Needs Study will be completed over the course of two days. Dr. Greg Rybarczyk and Troy Rosencrants will visit the WCRC for two days to assess the current state of GIS within the road commission. Greg and Troy will sit down with staff who use GIS currently to better understand what works/doesn?t work and how the current software is used. After the two day assessment, Greg and Troy will create a report detailing their findings of the current state of GIS within the WCRC, future goals, recommendations on how to reach those goals, and cost consideration going forward. Once the report is finished, the WCRC will receive and review the report. After the WCRC has reviewed the findings, they will discuss with the GISC how to best move forward with the project. Task 2 After the completion of Task 1, Task 2 will be able to be addressed. The report from Task 1 will include some recommendations of training for the staff at the WCRC. From these recommendations, the GISC will be able to create tailored workshops or training sessions for the stuff of WCRC to be completed at the University of Michigan-Flint in the July/August time frame. Training sessions will be 3-4 hours (half day) and will address specific needs of the WCRC. Task 3 The report from Task 1 will help determine the best approach to completing the small projects listed in Task 3. Starting first with the culvert inventory and storm water structures inventory, the GISC recommends sending Troy to the WCRC one day a week for 6 weeks (longer/shorter if necessary) to help oversee the data collection of these inventories. During this time, small project 3 (evaluating base maps/standardizing basemaps) could be started as well. After the completion of the first three small projects, projects 4 and 5 will be assessed for the best course of action.
Project Principal Investigator:
Martin Kaufman
Lead Institution:
University of Michigan Flint College of Arts and Sciences