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Despite the universally recognized importance of fostering trust and avoiding distrust in governance relationships, there remains considerable debate on core questions like the relation between (dis)trust and the evaluations of the characteristics that make a governance agent appear (un)worthy of trust. In particular, it remains unclear whether levels of (dis)trust simply follow levels of (dis)trustworthiness-such that building trust is primarily a question of increasing evidence of trustworthiness and avoiding evidence of distrustworthiness, or if their dynamics are more complicated. The current paper adds novel theory for thinking about the management of trust and distrust in the governance context through the application of principles borrowed from resilience theory. Specifically, we argue that trust and distrust exist as distinct, self-reinforcing (i.e., stable) states separated by a threshold. We then theorize as to the nature of the self-reinforcing processes and use qualitative data collected from and inductively coded in collaboration with Flint residents as part of a participatory process to look for evidence of our argument in a well-documented governance failure. We conclude by explaining how this novel perspective allows for clearer insight into the experience of this and other communities and speculate as to how it may help to better position governance actors to respond to future crises.

IntroductionThis protocol describes a study testing the efficacy of interpersonal psychotherapy (IPT) for major depressive disorder following perinatal loss (early and late fetal death and early neonatal death). Perinatal loss is associated with elevated risk of major depressive disorder and post-traumatic stress disorder (PTSD). Perinatal loss conveys specific treatment needs. The trial will be the first fully powered randomised trial of treatment for any psychiatric disorder following perinatal loss.Methods and analysisA sample of 274 women in Flint and Detroit areas in Michigan who experience a major depressive episode following a perinatal loss will be randomised to group IPT for perinatal loss or to group coping with depression. We anticipate that 50% of the sample will have co-occurring PTSD. Assessments occur at baseline, mid-treatment (8 weeks), post-treatment (16 weeks) and follow-up (28 weeks). Clinical outcomes include time to recovery from major depressive episode (primary), depressive symptoms, PTSD symptoms and time to recovery from PTSD. Additional outcomes include social support, social role functioning (including parental functioning for those with living children), well-being, grief (including complicated grief and fault beliefs) and fear of subsequent pregnancies. Social support and grief are hypothesised mediators of IPT effects on time to recovery from major depressive episode.Ethics and disseminationThe trial was approved by Michigan State University’s Biomedical Institutional Review Board. It has a data and safety monitoring board and has been submitted to the community-based organisation partners community ethics review board. Written operating procedures outline methods for protecting confidentiality, monitoring and recording adverse events, and safeguarding participants. We will share study results with research and clinical communities, community organisations through which we recruited, and will offer results to study participants. Deidentified datasets will be available through the National Institute of Mental Health Data Archive and to qualified investigators on request.Trial registration numberNCT04629599.

Structural racism causes stark health inequities and operates at every level of society, including the academic and governmental entities that support health research and practice. We argue that health research institutions must invest in research that actively disrupts racial hierarchies, with leadership from racially marginalized communities and scholars. We highlight synergies between antiracist principles and community-based participatory research (CBPR), examine the potential for CBPR to promote antiracist research and praxis, illustrate structural barriers to antiracist CBPR praxis, and offer examples of CBPR actions taken to disrupt structural racism. We make recommendations for the next generation of antiracist CBPR, including modify health research funding to center the priorities of racially marginalized communities, support sustained commitments and accountability to those communities by funders and research institutions, distribute research funds equitably across community and academic institutions, amplify antiracist praxis through translation of research to policy, and adopt institutional practices that support reflection and adaptation of CBPR to align with emergent community priorities and antiracist practices. A critical application of CBPR principles offers pathways to transforming institutional practices that reproduce and reinforce racial inequities. (Am J Public Health. 2023;113(1):70–78. https://doi.org/10.2105/AJPH.2022.307114 )

The past two decades have been marked by increased community involvement in the research process. Community-engaged research (CEnR) is increasingly promoted in the literature, and academic programs with a community-academic partnership focus. Community-based participatory research (CBPR) is an approach to frame equitable community involvement in research and is a critical component of the CEnR continuum. As with CEnR, noted benefits of using CBPR expressed in the literature, which include enhancing the relevance and application of the research data, expertise to complex problems at all stages of research, overcoming community distrust, and improving community health. This article presents a community engagement (CE) model that includes seven defined designations for CEnR. In addition, this model includes equity indicators and contextual factors for consideration at the various levels of engagement along the continuum. The CE model described in this article combines the principles of CE and CBPR in conjunction with a continuum model. The continuum integrates a focus on health equity and contextual factors providing perspectives from both community and academic partners at each point of engagement. A broadly defined CEnR continuum will allow researchers, community members and organizations to readily identify 1) where they are on the continuum of CEnR, 2) appropriate access points to enter the continuum based on existing contextual factors, and 3) actions to promote progression on the continuum. Funders have the opportunity to specify the appropriate level of CE needed to accomplish the goals of their identified priorities.

Community-engaged partnerships (community/academia/government) can play a role in developing effective protocols that address public health crises. Systemic racism, prioritization of money over humanity, and the repression of the local democratic processes through the State of Michigan Emergency Manager Law (Order of Act 439) all played a role in the Flint Water Crisis. Despite decades of collaboration between Flint-based community organizations and academic institutions, ways to navigate such crises and conduct relevant research were ineffective. The Michigan Institute for Clinical and Health Research Community Engagement program at the University of Michigan and Flint's Community Based Organization Partners co-developed the Research Readiness and Partnership Protocol (R2P2) to provide community-engaged recommendations that inform a rapid research response to public health emergencies. The R2P2 Workgroup conducted an extensive literature review and key interviews to inform protocol development. This manuscript provides an overview of the Workgroup's methods, key interview findings, and the main principles identified. Detailed recommendations and key elements to address prior to and during a crisis will be presented including methods for: establishing and maintaining trust, ensuring transparency, supporting clear communication, establishing a \"front door\" to academic institutions including a means to \"sound the alarm,\" addressing academic incentives, achieving equitable resource sharing, and addressing systemic racism. This manuscript of community perspectives provides essential elements to develop meaningful community-academic research partnerships to address public health crises impacting communities, particularly communities of color. Furthermore, this work highlights an opportunity for greater acknowledgment and utilization of community-based participatory research (CBPR) by academic institutions.

African Americans and other minorities (AAOM) are under-represented in careers in medicine, public health, and research. Furthermore, African Americans suffer more disproportionately from racial health disparities across most health indicators. Scholars suggest that the underrepresentation of AAOM public health and medical professionals contributes to the racial and ethnic health disparity trends in the USA. Thus, an increase in African American public health professionals may lead to a decrease in health disparities in African American communities. This manuscript will share a qualitative research study designed to explore motivators to engage African American students into careers in public health. Grounded theory and the feedforward model were used to explore critical career motivators, career decisions, career trajectories, barriers, and methods to overcome barriers among 20 African American public health graduate students and professionals. Eight motivators and six recommendations were identified to engage African Americans into careers in Public Health.

This manuscript describes a telephone outreach project for members of a research registry program for older adults in Detroit, Michigan. From April until December 2020, the Healthier Black Elders Center designed and implemented a telephone outreach program, calling 1204 older adults utilizing 15 staff and volunteers. The calls served to check in on registry members and collect data on mental health, coping mechanisms, access to services, masks, testing, and tele-health. This paper details the methods of developing and implementing an innovative engagement program that collected time-sensitive data from older Black adults that has directly been applied to create virtual health education programs, share resource information, and create a program to reduce social isolation.

Eleven years have passed since the 2014 Flint water crisis (FWC), yet many voices still go unheard. There is limited evidence of the impact of the FWC on maternal health. This paper used a cross-sectional study design to survey 152 women enrolled in the Supporting Parents and Raising Resilient Kids (SPARRK) study in Flint, Michigan to examine racial differences in women's perceptions of their overall health pre- and post-FWC, perceived maternal health services, and explore the interaction of race and living in Flint on maternal morbidity. Perceived maternal health was defined using the Centers for Disease Control and Prevention's 21 Severe Maternal Morbidity (SMM) diagnosis codes. SMM were obtained via questionnaire. Logistic regression analyses were performed to identify factors associated with SMM within two domains: (1) overall health pre- and post-FWC and (2) perceived maternal health care received during birth. There were 17 cases of SMM in which Black women accounted for 62.5% of these cases. Perceived quality of care was overall positive; yet, perceived overall health decreased post-FWC for all women. The odds of SMM were 6 times higher for those who had a college degree or higher. In the predominately Black city of Flint, race was not a significant factor in the perception of health and quality of care. Surprisingly, educational attainment was significantly associated with a 6-time increase in odds of experiencing an SMM. More research is needed to examine the association of patient-provider perception of quality care and education on maternal health outcomes.