Angry, Scared, and Unsure: Mental Health Consequences of Contaminated Water in Flint, Michigan

Environmental pollution and extreme weather conditions: insights into the effect on mental health

Environmental pollution exposures, including air, soil, water, light, and noise pollution, are critical issues that may implicate adverse mental health outcomes. Extreme weather conditions, such as hurricanes, floods, wildfires, and droughts, may also cause long-term severe concerns. However, the knowledge about possible psychiatric disorders associated with these exposures is currently not well disseminated. In this review, we aim to summarize the current knowledge on the impact of environmental pollution and extreme weather conditions on mental health, focusing on anxiety spectrum disorders, autism spectrum disorders, schizophrenia, and depression. In air pollution studies, increased concentrations of PM2.5, NO2, and SO2 were the most strongly associated with the exacerbation of anxiety, schizophrenia, and depression symptoms. We provide an overview of the suggested underlying pathomechanisms involved. We highlight that the pathogenesis of environmental pollution-related diseases is multifactorial, including increased oxidative stress, systematic inflammation, disruption of the blood-brain barrier, and epigenetic dysregulation. Light pollution and noise pollution were correlated with an increased risk of neurodegenerative disorders, particularly Alzheimer's disease. Moreover, the impact of soil and water pollution is discussed. Such compounds as crude oil, heavy metals, natural gas, agro-chemicals (pesticides, herbicides, and fertilizers), polycyclic or polynuclear aromatic hydrocarbons (PAH), solvents, lead (Pb), and asbestos were associated with detrimental impact on mental health. Extreme weather conditions were linked to depression and anxiety spectrum disorders, namely PTSD. Several policy recommendations and awareness campaigns should be implemented, advocating for the advancement of high-quality urbanization, the mitigation of environmental pollution, and, consequently, the enhancement of residents' mental health.

'Environmental standard limit concentration' arsenic exposure is associated with anxiety, depression, and autism-like changes in early-life stage zebrafish

Arsenic is a worldwide environmental pollutant that can impair human health. Previous studies have identified mental disorders induced by arsenic, but the environmental exposure concentrations in the early life stages associated with these disorders are poorly understood. In the present study, early-life stage zebrafish were used to explore the effects on mental disorders under 'environmental standard limit concentrations' arsenic exposures of 5, 10, 50, 150, and 500 μg/L. The results showed that arsenic exposure at these concentrations changed the locomotor behavior in larval zebrafish and was further associated with anxiety, depression, and autism-like behavior in both larval and juvenile zebrafish. Changes were noted at benchmark dose limit (BMDL) concentrations as low as 0.81 μg/L. Transcriptomics showed that immediate early genes (IEGs) fosab, egr1, egr2a, ier2b, egr3, and jund were decreased after arsenic exposure in larval and juvenile zebrafish. Nervous system impairment and anxiety, depression, and autism-like behaviors in early-life stage zebrafish at 'environmental standard limit concentrations' may be attributed to the downregulation of IEGs. These findings in zebrafish provided new experimental support for an arsenic toxicity threshold for mental disorders, and they suggest that low levels of environmental chemicals may be causative developmental factors for mental disorders.

Mental health impacts of environmental exposures: A scoping review of evaluative instruments

To date, much of the health focus of environmental policy has been on preventing physical health impacts of environmental exposures. Recent research has however highlighted increasingly concurrent mental health effects and its consideration is an emerging requirement for many governments and their agencies, yet there are limited universal mental health assessment tools for environmental exposures. This paper details the findings of a scoping review that evaluated assessment tools used to measure psychological impacts from environmental exposures and pollution, as reported in recent peer-reviewed literature (2000-2022). Across the 126 papers identified in our review, a wide range of tools to assess mental health impact were identified. We document a clear recent upswing of research interest in the mental and psychological impacts of environmental exposures, and an overarching concern for air pollution from industry, traffic, and fires. A majority of studies utilised standardised assessment instruments, but there was little consistency in the way that these were combined or deployed. The dominant mental health outcomes of interest in these studies were depression, anxiety, and mental and psychiatric health. The findings of the review identify a need and opportunity to develop a best-practice approach to consistently assess the mental health impacts arising from environmental exposures. Future work is needed to define the most appropriate choice and application of assessment tools to evaluate adverse mental health impacts from environmental exposures. This will support a more universal, coordinated and cross-jurisdiction approach for the assessment, quantification and targeted response to addressing mental health impacts arising from environmental exposures.

Water, Water Everywhere, but Every Drop Unique: Challenges in the Science to Understand the Role of Contaminants of Emerging Concern in the Management of Drinking Water Supplies

The protection and management of water resources continues to be challenged by multiple and ongoing factors such as shifts in demographic, social, economic, and public health requirements. Physical limitations placed on access to potable supplies include natural and human-caused factors such as aquifer depletion, aging infrastructure, saltwater intrusion, floods, and drought. These factors, although varying in magnitude, spatial extent, and timing, can exacerbate the potential for contaminants of concern (CECs) to be present in sources of drinking water, infrastructure, premise plumbing and associated tap water. This monograph examines how current and emerging scientific efforts and technologies increase our understanding of the range of CECs and drinking water issues facing current and future populations. It is not intended to be read in one sitting, but is instead a starting point for scientists wanting to learn more about the issues surrounding CECs. This text discusses the topical evolution CECs over time (Section 1), improvements in measuring chemical and microbial CECs, through both analysis of concentration and toxicity (Section 2) and modeling CEC exposure and fate (Section 3), forms of treatment effective at removing chemical and microbial CECs (Section 4), and potential for human health impacts from exposure to CECs (Section 5). The paper concludes with how changes to water quantity, both scarcity and surpluses, could affect water quality (Section 6). Taken together, these sections document the past 25 years of CEC research and the regulatory response to these contaminants, the current work to identify and monitor CECs and mitigate exposure, and the challenges facing the future.

Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset

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.

Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity

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.

Did a nocebo effect contribute to the rise in special education enrollment following the Flint, Michigan water crisis?

Background

Exposure to waterborne lead during the Flint Water Crisis during April 2014-October 2015 is believed to have caused increased special education enrollment in Flint children.

Method

This retrospective population-based cohort study utilized de-identified data for children under six years of age who had their blood lead tested during 2011 to 2019, and special education outcomes data for children enrolled in public schools for corresponding academic years (2011-12 to 2019-20) in Flint, Detroit (control city) and the State of Michigan. Trends in the following crisis-related covariates were also evaluated: waterborne contaminants, poverty, nutrition, city governance, school district policies, negative community expectations, media coverage and social media interactions.

Results

Between 2011 and 2019, including the 2014-15 crisis period, the incidence of elevated blood lead in Flint children (≥ 5µg/dL) was always at least 47% lower than in the control city of Detroit (p < .0001) and was also never significantly higher than that for all children tested in Michigan (p = 0.33). Nonetheless, special education enrollment in Flint spiked relative to Detroit and Michigan (p < .0001). There is actually an inverse relationship between childhood blood lead and special education enrollment in Flint.

Conclusion

This study failed to confirm any positive association between actual childhood blood lead levels and special education enrollment in Flint. Negative psychological effects associated with media predictions of brain damage could have created a self-fulfilling prophecy via a nocebo effect. The findings demonstrate a need for improved media coverage of complex events like the Flint Water Crisis.

Examining Community Engagement Research Strategies Used in Flint, Michigan: The Church Challenge

BACKGROUND

The ways in which researchers may need to adapt traditional community-based participatory research engagement strategies during ongoing community trauma are understudied. We describe our efforts to engage the Flint, Michigan community in community-based participatory research in the aftermath of the Flint Water Crisis.

OBJECTIVES

This manuscript describes 1) recruitment strategies selected before the Flint Water Crisis, 2) engagement lessons learned in the context of the Flint Water Crisis, and 3) barriers and facilitators encountered while engaging African American churches.

METHODS

Researchers collaborated with community partners to engage and recruit a traumatized Flint community into the Church Challenge, a multilevel intervention to reduce chronic disease burden.

LESSONS LEARNED

Recruitment and engagement strategies must be flexible, innovative, and may require nontraditional methods.

CONCLUSIONS

Flexibility and adaptability are crucial for engaging with a traumatized community. Community-based participatory research work in traumatized communities must acknowledge and respond to community trauma to be successful.

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.

Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis

IMPORTANCE

Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures.

OBJECTIVE

To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates.

MAIN OUTCOMES AND MEASURES

Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.

RESULTS

Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family's health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis-related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.

The Differential Consequences of Fear, Anger, and Depression in Response to COVID-19 in South Korea

Studies on previous outbreaks of contagious diseases suggest that the impact of the emotions associated with an epidemic can be greater than that of the epidemic in terms of the number of people affected. This study explores the relationships between the three most commonly expressed emotional responses to the COVID-19 pandemic (fear, anger, and depression) and two outcome variables (compliance with the social-distancing policy and the stigmatization of those infected by COVID-19). A large online, public opinion survey was conducted in South Korea (n = 1000) between 4 and 11 June 2020, which was between the first and the second waves of COVID-19. A series of regression analyses suggest that the emotional response was accompanied by differential behavioral and perceptual consequences. Fear was consistently positively related to all indicators of compliance with social-distancing policies (the voluntary practice of social distancing, support for the “routine-life-distancing” policy, and support for stronger social-distancing policies). Anger was positively related to both stigmatization indicators (responsibility attribution and stigmatizing attitude toward people infected with COVID-19). Finally, depression showed negative relationships with support for the “routine-life-distancing” policy and for stronger social-distancing policies but a positive relationship with the voluntary practice of social distancing. By examining whether and how certain types of emotional responses are more or less related to compliance with social distancing and stigmatization, the present study provides practical implications for effective public communication during an epidemic such as COVID-19.

The Interplay of Environmental Exposures and Mental Health: Setting an Agenda

BACKGROUND

To date, health-effects research on environmental stressors has rarely focused on behavioral and mental health outcomes. That lack of research is beginning to change. Science and policy experts in the environmental and behavioral health sciences are coming together to explore converging evidence on the relationship-harmful or beneficial-between environmental factors and mental health.

OBJECTIVES

To organize evidence and catalyze new findings, the National Academy of Sciences, Engineering, and Medicine (NASEM) hosted a workshop 2-3 February 2021 on the interplay of environmental exposures and mental health outcomes.

METHODS

This commentary provides a nonsystematic, expert-guided conceptual review and interdisciplinary perspective on the convergence of environmental and mental health, drawing from hypotheses, findings, and research gaps presented and discussed at the workshop. Featured is an overview of what is known about the intersection of the environment and mental health, focusing on the effects of neurotoxic pollutants, threats related to climate change, and the importance of health promoting environments, such as urban green spaces.

DISCUSSION

We describe what can be gained by bridging environmental and psychological research disciplines and present a synthesis of what is needed to advance interdisciplinary investigations. We also consider the implications of the current evidence for a) foundational knowledge of the etiology of mental health and illness, b) toxicant policy and regulation, c) definitions of climate adaptation and community resilience, d) interventions targeting marginalized communities, and e) the future of research training and funding. We include a call to action for environmental and mental health researchers, focusing on the environmental contributions to mental health to unlock primary prevention strategies at the population level and open equitable paths for preventing mental disorders and achieving optimal mental health for all. https://doi.org/10.1289/EHP9889.

Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge

Introduction

The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned.

Methods

The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages.

Results

We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change.

Lessons Learned

Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts.

Discussion

Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches.

Conclusion

Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.

Structural Barriers Associated with the Intersection of Traumatic Stress and Gun Violence: A Case Example of New Orleans

Gun violence drastically increased in urban cities following the ease of shutdown restrictions associated with the Coronavirus Pandemic. The association of gun violence and COVID-19 has highlighted the importance of taking a public health perspective, particularly as it relates to impacts on the Black community. In this article we discuss macro-level factors and community traumas in the city of New Orleans, an area that has had longstanding issues related to gun violence. Community structural issues, traumatic stress from disasters, and recommendations to address disparities in social determinants of health are discussed.

The Clarion Call of the COVID-19 Pandemic: How Medical Education Can Mitigate Racial and Ethnic Disparities

Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.

Bringing Inclusion Into Pediatric Primary Health Care: A Systematic Review of the Behavioral Health Treatment of Racial and Ethnic Minority Youth

INTRODUCTION

Currently, pediatric behavioral health care accounts for one of the fastest growing health care expenditures. Children representing racial and ethnic minority groups are still found to experience significant behavioral health needs. Primary health care represents the first level of contact with the health care system.

METHOD

The purpose of this systematic review was to synthesize articles discussing the behavioral health needs and treatment of racial and ethnic minority in primary care settings.

RESULTS

Results yielded 40 articles meeting the inclusion criteria. Themes included: provider screening, provider selected treatments, prevalence and need, and stigma and patient-provider communication.

CONCLUSIONS

Themes were discussed through the Ecological Systems Theory lens. Study limitations included its exclusion of intellectual disabilities like Autism Spectrum Disorder, lack of literature utilizing large minority samples, and lack of attention to the intersection between race and/or ethnicity alongside other demographics of concern like gender, age, social class, and geographical location.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan

BACKGROUND

While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting.

METHODS

This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software.

RESULTS

Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight.

CONCLUSIONS

Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Psychological Consequences of the Flint Water Crisis: A Scoping Review

OBJECTIVE

To summarize existing literature on the mental health impact of the Flint Water Crisis.

METHODS

In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted.

RESULTS

32 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.

CONCLUSIONS

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.

Chronic environmental contamination: A narrative review of psychosocial health consequences, risk factors, and pathways to community resilience

A body of psychological and social scientific evidence suggests that the experience of technological disaster or long-term exposure to environmental contamination can be psychologically stressful. Addressing the psychosocial impact in communities living with chronic contamination is therefore a vital part of improving their resilience. Guided by a synthetic theoretical model of the unique psychosocial impact of chronic environmental contamination (in contrast to natural and technological disasters, and background pollution), we undertook a narrative review to assess the current research on this important social problem. Relevant qualitative peer-reviewed studies and grey literature were examined to derive a model identifying likely factors increasing risk for distress in chronic contamination experience and actions that may be taken by public health professionals and local leaders to enhance community resilience and take health-protective actions. Based on our initial theoretical model and the literature reviewed, we emphasize the importance of considering both the material and social dimensions of chronic environmental contamination experience. For instance, our review of the qualitative literature suggests that individuals who attribute material health impacts to contamination, and who have the social experience of their concerns being delegitimized by responsible institutions, are most at risk for psychological stress. Psychological stress in the context of chronic contamination is an important potential public health burden and a key area for additional research.

Rolling back the gains: Maternal stress undermines pregnancy health after Flint's water switch

Environmental disasters impact disadvantaged communities disproportionately both through the epidemiological challenge of exposure, but also by undermining the progress of public health efforts. This paper studies changes to smoking cessation, breastfeeding, and weight gain during pregnancy in the period following the switch in water supply in Flint, Michigan, in April 2014. As the switch resulted in immediate and significant deterioration in water quality, eventually leading to its contamination with lead, we estimate a 10.5 percentage point increase in smoking and a 2.1 percentage point decrease in breastfeeding. We show evidence that these changes in maternal behavior are linked to increased stress due to changing water quality. We estimate that the increase in smoking alone is responsible for most of the increase in incidence of low birthweight among infants in Flint, resulting in $700 additional costs per birth. Increased smoking during pregnancy and lower breastfeeding rates in Flint roll back years of public health efforts, resulting in lifetime higher rates of cardiovascular disease, diabetes, and cancer for mothers in the community.

Worry during the initial height of the COVID-19 crisis in an Italian sample

In the earliest months of 2020, the COVID-19 emergency reached a pandemic status of international concern. In this situation, people tended to think more about current difficulties and their negative consequences due to the fear of infection and changed daily life during quarantine. The aim of this study was to explore the severity of worry in relation to individual characteristics and emotions during COVID-19 outbreak in the Italian people. Socio-demographic questions and standardized self-report questionnaires were administered online. Results highlighted a moderate level of worry, anxiety and distress. People with higher perceptions of COVID-19 severity exhibited higher levels of worry in contrast to those who perceived a greater control over the possibility of infection. Multiple regression analysis indicated that coping styles, emotion regulation strategies and personality traits significantly contributed to explain the variance in worry scores. Findings supported that cognitive reappraisal, emotion-focused coping and extraversion were protective factors for worry, while expressive suppression, dysfunctional and problem-focused coping, and neuroticism were related to high worry. However, neuroticism and dysfunctional coping were particularly important predictors of worry. This paper also considers possible psychological interventions that might be implemented in order to deal with mental health issues emanating from the COVID-19 pandemic.

Exploring Community Psychosocial Stress Related to Per- and Poly-Fluoroalkyl Substances (PFAS) Contamination: Lessons Learned from a Qualitative Study

The purpose of this study was to qualitatively explore the per- and poly-fluoroalkyl substances (PFAS) exposure experience and associated stressors, to inform public health efforts to support psychosocial health and resilience in affected communities. Semi-structured interviews (n = 9) were conducted from July-September 2019 with community members and state public health department representatives from areas with PFAS-contaminated drinking water. Thematic analysis was completed and themes were described and summarized. Reported stressors included health concerns and uncertainty, institutional delegitimization and associated distrust, and financial burdens. Interviewees provided several strategies to reduce stress and promote stress coping capacity and resilience, including showing empathy and validating the normalcy of experiencing stress; building trust through visible action and sustained community engagement; providing information and actionable guidance; discussing stress carefully; fostering stress coping capacity and resilience with opportunities to build social capital and restore agency; and building capacity among government agencies and health care providers to address psychosocial stress. While communities affected by PFAS contamination will face unavoidable stressors, positive interactions with government responders and health care providers may help reduce negative stress. More research on how best to integrate community psychosocial health and stress coping and resilience concepts into the public health response to environmental contamination could be helpful in addressing these stressors.

Water and mental health

There is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.

This article is categorized under:

Stress, Coping, Resilience and Trust during the Flint Water Crisis

In 2014, government officials in the City of Flint, Michigan switched the municipal water source from the Detroit Water System (water source: Lake Huron) to the Flint River. During this time, an estimated 102,000 Flint residents were potentially exposed to multiple chemical (e.g., lead) and biological threats (e.g., Legionella). After the switch to water sourced from the Flint River, Flint residents consistently reported concerns over water quality while also experiencing rashes, hair loss, and other health problems, including anxiety and depression. This study 1) reports on the Flint Water Crisis and its subsequent impact on residents' stress, coping, resilience and trust and 2) describes a process methodology that trained, hired and deployed Flint residents as members of a multidisciplinary research team. A random sample of 320 Flint residents underwent household-based interviews to assess their health and mental health needs. Concomitantly, household water samples were obtained and residents were connected to known resources based on interview responses relative to need. This study found that declines in health and mental health status were correlated with increased stressors (i.e., fatigue, financial concern, anxiety), coping and less resilience or the capacity to recover. Perceived trust in government officials was significantly lower after the water crisis. While the water crisis generated numerous stressors, the event also galvanized community competence to engage in solution-focused coping and other adaptive capacities. By assessing and building upon Flint residents' resilience, community resource specialists, identified and subsequently strengthened city residents' ability to survive devastating challenges.

Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations

Mental health clinicians and researchers must be prepared to address the unique needs of Black Americans who have been disproportionately affected by the COVID-19 pandemic. Race-conscious and culturally competent interventions that consider factors such as discrimination, distrust of health care providers, and historical and racial trauma as well as protective factors including social support and culturally sanctioned coping strategies are needed. Research to accurately assess and design treatments for the mental health consequences of COVID-19 among Black Americans is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Racial Capitalism: A Fundamental Cause of Novel Coronavirus (COVID-19) Pandemic Inequities in the United States

Racial capitalism is a fundamental cause of the racial and socioeconomic inequities within the novel coronavirus pandemic (COVID-19) in the United States. The overrepresentation of Black death reported in Detroit, Michigan is a case study for this argument. Racism and capitalism mutually construct harmful social conditions that fundamentally shape COVID-19 disease inequities because they (a) shape multiple diseases that interact with COVID-19 to influence poor health outcomes; (b) affect disease outcomes through increasing multiple risk factors for poor, people of color, including racial residential segregation, homelessness, and medical bias; (c) shape access to flexible resources, such as medical knowledge and freedom, which can be used to minimize both risks and the consequences of disease; and (d) replicate historical patterns of inequities within pandemics, despite newer intervening mechanisms thought to ameliorate health consequences. Interventions should address social inequality to achieve health equity across pandemics.

Ecological Disasters and Mental Health: Causes, Consequences, and Interventions

Ecological disasters highlight the importance of understanding natural disasters as they relate to a changing global climate. Such disasters often have a predictable pattern of evolving over time and anticipated psychological and behavioral problems and community disruptions. Various factors enhance transmission of these adverse effects beyond the geographic location of the ecological disaster, with certain populations being particularly vulnerable to these effects. Understanding the range and pattern of these effects can aid in optimizing interventions. The use of evidence-informed interventions can reduce distress, enhance well-being, and improve functioning for affected individuals and communities. Effective preparedness involves an understanding of these factors, incorporation of them at all stages of disaster management, and continuous education and training for disaster planners and responders.

Study of the Water Quality of a Tropical Reservoir

A study of the water quality of the Adolfo López Mateos Reservoir (ALMD) was developed through different indicators from a spatial and seasonal perspective. Variables related to the general characteristics of water quality, trophic level, and ecological risk were assessed through the National Sanitation Foundation–Brown Water Quality Index (WQINSF–BROWN), the Carlson Trophic State Index (TSICARLSON) and the Håkanson Ecological Risk Index (RIHÅKANSON). Using data from physical, chemical, and biological parameters obtained from four sampling points in the ALMD, the water quality was assessed in each model used. The results indicated that the reservoir presents a water quality classified as “medium” (WQINSF–BROWN = 70), where significant variations in the concentrations of some parameters are observed. The reservoir showed a general trophic state (TSIGENERAL-AVERAGE = 43.04) classified as “mesotrophic”. The ecological risk analysis achieved the best classification of the methodology, discarding contamination by heavy metals in surface waters. This type of applied methodology will help in decision-making tools in the dam, and can be applied in other dams in the region.

Sociodemographic predictors of residents worry about contaminated sites

The management and remediation of contaminated environments increasingly involves engagement with affected local residents. Of late, risk communication tools and guidelines have drawn attention to the stress and concern of residents as a result of heightened awareness of localised contamination and the need to address these less visible impacts of contamination when engaging with affected communities. Despite this emerging focus, there is an absence of research exploring the factors that predict resident worry about neighbourhood contamination. This paper aims to address this shortcoming by drawing on data from a cross-sectional survey of 2009 adult residents in neighbourhoods near 13 contaminated sites across Australia. Analyses used ordered logistic regression to determine the sociodemographic, environmental, and knowledge-based factors that influence residents' degree of worry. The findings suggest age, gender and income significantly affect residents' degree of worry. Being knowledgeable about the contaminant was associated with lower degrees of worry. Conversely, having a stronger sense of place within a neighbourhood predicted higher degrees of worry. Type of contaminant also impacted resident worry, with residents being less likely to worry about hydrocarbon, asbestos and waste than other types of contaminants. Our analyses suggest resident worry can be reduced through improving access to accurate information and the development of specific risk reduction strategies tailored to each neighbourhood and aimed at the heterogeneous distribution of worry amongst residential populations.

Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors

This article provides an overview of research on race-related stressors that can affect the mental health of socially disadvantaged racial and ethnic populations. It begins by reviewing the research on self-reported discrimination and mental health. Although discrimination is the most studied aspect of racism, racism can also affect mental health through structural/institutional mechanisms and racism that is deeply embedded in the larger culture. Key priorities for research include more systematic attention to stress proliferation processes due to institutional racism, the assessment of stressful experiences linked to natural or manmade environmental crises, documenting and understanding the health effects of hostility against immigrants and people of color, cataloguing and quantifying protective resources, and enhancing our understanding of the complex association between physical and mental health.

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

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Voices from Flint: Community Perceptions of the Flint Water Crisis

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.