Community Assessment for Public Health Emergency Response (CASPER) after the Flint Water Crisis

Wednesday, June 7, 2017: 11:10 AM
430A, Boise Centre
Alice Wang , Centers for Disease Control and Prevention, Atlanta, GA
Gamola Z Fortenberry , Centers for Disease Control and Prevention, Atlanta, GA
Patricia Reynolds , Genesee Health System, Flint, MI
Sherry Burrer , Centers for Disease Control and Prevention, Atlanta, GA
Vicki Johnson-Lawrence , University of Michigan-Flint, Flint, MI
Amy Schnall , Centers for Disease Control and Prevention, Atlanta, GA
Price Pullins , Michigan Department of Community Health, Flint, MI
Stephanie Kieszak , Centers for Disease Control and Prevention, Atlanta, GA
Tesfaye Bayleyegn , Centers for Disease Control and Prevention, Atlanta, GA
Amy Wolkin , Centers for Disease Control and Prevention, Atlanta, GA

BACKGROUND: On April 25, 2014, the City of Flint, Michigan (population approximately 102,000) changed their municipal water supply from the Detroit-supplied Lake Huron water to the Flint River. The switch resulted in the corrosion of water distribution pipes and leaching of lead and other contaminants into municipal drinking water; this prompted an official advisory not to drink unfiltered municipal water. In addition to health effects from lead exposure, there were concerns about behavioral health effects from the Flint Water Crisis. To assist in recovery efforts, Flint Community Resilience Group and Centers for Disease Control and Prevention staff assessed physical and behavioral health concerns of the community.

METHODS: We used a three-stage cluster sampling design to conduct a Community Assessment for Public Health Emergency Response (CASPER), May 17–19, 2016. The questionnaire elicited information about household- and individual-level physical and behavioral health concerns since the Flint Water Crisis. Individual-level behavioral health questions were adapted from the Behavioral Risk Factor Surveillance System (BRFSS). We conducted household- and individual-level weighted cluster analysis with 95% confidence intervals (CI), and compared individual-level results to 2014 Michigan BRFSS findings.

RESULTS: We completed 182 household surveys (completion rate=86.7%). Of households, 50.5% (CI: 43.4–57.5) reported worsened physical health of at least one household member (e.g., skin rash, hair loss, fatigue). Half (50.0%, CI: 41.8–58.3) the households reported a lot of stress related to feeling overlooked by decision-makers. Of individuals, 29.6% (CI: 21.2–38.0) self-reported depressive symptoms and 33.7% (CI: 25.5–41.8) self-reported symptoms of anxiety. Approximately 38.0% (CI: 31.6–44.4) of individuals reported having poor mental health for 14 or more days within the last 30 days, compared to 12.9% (CI: 11.9–14.0) for the total population of Michigan as reported in the 2014 Michigan BRFSS.

CONCLUSIONS:  The percentage of Flint residents reporting behavioral health concerns was approximately three times higher than reported by the 2014 Michigan BRFSS. The CASPER findings of an increased prevalence of negative quality of life indicators for individuals and a considerable percentage of individuals reporting symptoms of depression and anxiety along with household behavioral health concerns supported the additional resources allocated for behavioral health intervention and follow-up surveillance of behavior health concerns to the ongoing recovery efforts of the Flint Water Crisis.