Reports and Publications
Reports
2026
Flint Lead Free 2025
The 2025 Flint Lead Free report is a comprehensive summary of the progress made by Flint community partners toward the goal of lead elimination and reduced environmental lead exposure in Flint.
Flint Registry 2025 Annual Report
The 2025 report highlights health concerns, connections to services, and strengthening community engagement over a decade after the Flint water crisis. The Flint Registry remains one of the largest public health registries in the country and continues to serve as a critical connector to a healthier future for Flint residents – and other similarly impacted communities. The annual report also looks at future priorities, including continued surveys and deeper engagement with residents. In summer 2026, the Flint Registry plans to launch a mini survey focused on issues identified as most important by the community, including current well-being, mental health, and access to resources.
2024
Flint Registry 2023 Annual Report
It has been almost ten years since the Flint water crisis began in April of 2014. In this year’s annual report, we reflect on the work of the Flint Registry to support recovery from the water crisis. We share the stories of those who have participated and how those stories have impacted other communities around the country. We also present data on the top health concerns affecting families and how the Flint Registry is improving the health of the Flint community.
2023
Flint Lead Free 2023 Report: Data Trends & Multi-Sector Collaboration
By Mona Hanna-Attisha, Jenny LaChance, and Lydia Starrs
With a mission of eliminating lead exposure, Flint Lead Free is a data-driven and multi-sector group identifying the burden of environmental lead exposure and eliminating lead exposure disparities.
2022
Legal Handbook for Establishing a Public Health Registry
By Colleen Healy Boufides, Jennifer Bernstein, Denise Chrysler, and Peter D. Jacobson
Regents of the University of Michigan
After Flint residents were exposed to lead during the Flint water crisis, the community came together to create the Flint Registry to monitor community health, connect people to services, and promote an understanding of how the water crisis affected the community. A team of community members and experts had to solve complex operational and legal issues to establish the Flint Registry. This legal handbook examines the process of establishing and operating a community-based non-governmental environmental exposure registry. The authors share lessons learned to guide other communities wishing to establish non-governmental public health registries.
Flint Registry Inaugural Report: 2017-2021
Entering its fifth year of work, the Flint Registry is proud to present a report on its first four years of service. As of July 31, 2021, 16,076 people enrolled in the Flint Registry. Nearly 70% of those enrolled are adults. The oldest Flint Registry participant is 104 years old and the youngest is two years old. The Flint Registry made over 91,000 phone calls, sent 272,000 mailings, and hosted 441 community events in its first four years of programming.
2021
Flint Lead Free: Data Trends & Multi-Sector Collaboration 2021 Report
By Mona Hanna-Attisha, Jenny LaChance, and Lydia Starrs
Flint Lead Free serves as a clearinghouse of lead-related programming, education, and training for a variety of audiences such as residents, outreach workers, home visitors, construction workers, and Flint Registry staff. The program’s primary prevention and data-driven focus seeks to identify lead risks and service gaps, strategically align resources, and determine cost-effectiveness, return on investment, and translatability of local lead elimination.
2018
Flint Lead Free: 2017 Report
Flint Lead Free serves as a clearinghouse of lead-related programming, education, and training for a variety of audiences such as residents, outreach workers, home visitors, construction workers, and Flint Registry staff. The program’s primary prevention and data-driven focus seeks to identify lead risks and service gaps, strategically align resources, and determine cost-effectiveness, return on investment, and translatability of local lead elimination. This report highlights lead-related trends emphasizing primary prevention efforts underway in the City of Flint.
Publications
2025
Characteristics of Participants Who Consented to Share Data with a Public Health Registry after an Environmental Disaster
By Marty Crawford, Diana Haggerty, and Nicole Jones
International Journal of Environmental Research and Public Health
This descriptive study was conducted to provide details on the tiered consent process of the Flint Registry and on the individual characteristics of those who consented. This study found that most of the participants agreed to be contacted about future research opportunities. Also, the results showed that consent rates increased with age and decreased with income and education levels, although rates among those with reported food insecurity were higher than for other participants.
Creating a community resource for neuropsychological assessments after a lead exposure: Process and findings
By Diana Haggerty, Shuting Zheng, Lauren Tompkins, Eric Finegood, Jasmine Hall, Nicole Jones, and Mona Hanna
Disaster Medicine and Public Health Preparedness
This article describes the implementation of the Center for Children’s Integrated Services Assessment Center (CISAC). The CISAC was established after the Flint water crisis to provide neuropsychological assessments and recommendations for exposed children. This article also reports the different diagnoses of the first cohort of children assessed by CISAC.
Factors Associated with Fruit and Vegetable Intake Among Women of Reproductive Age in Flint, Michigan: A Cross-Sectional Analysis
By Gayle Shipp, Diana Haggerty, Amy Saxe-Custack, Jenny LaChance, and Nicole Jones
Healthcare
This study examined the association between sociodemographic, perceived health, and environmental factors with fruit and vegetable (F&V) consumption and adherence to dietary recommendations among women of reproductive age enrolled in the Flint Registry. Although perceived quality and access were high, adherence to dietary recommendations among this population was low. However, other factors associated with F&V intake were education, income, homeownership status, and perceived health and wellbeing.
Youth Depression After an Environmental Disaster: Is There a Relationship to Caregiver Stress and Depression?
By Jacqueline Dannis, Sarah Jenuwine, Kenyatta Dotson, and Nicole Jones
Child: Care, Health and Development
While the prevalence of depression symptoms was higher in Flint girls than in the general US population, it was not as high at 1-year follow-up. This study found that girls’ depression symptoms and their caregivers’ depression symptoms and stress were related. Both children and caregivers need access to mental health services.
Racial Differences in Residential Mobility After the Flint Water Crisis: A Survival Analysis
By Samantha Gailey, Richard Casey Sadler, Alan Harris, Sarah Jenuwine, Jacqueline Dannis, and Nicole Jones
Social Science & Medicine
Looking at where Flint adults lived between 2014 and 2019, not many Flint Registry enrollees moved out of the city. But white residents were 3 times more likely to move out of Flint than Black residents were. This may affect health equity.
Perceived Harm to Pet Health Associated with Human Quality of Life After a Public Health Disaster
By Diana Haggerty, Robert Wahl, Nicole Jones, Jenny LaChance, and Mona Hanna
International Journal of Environmental Research and Public Health
Both pets and humans were exposed to the Flint water crisis. This study of Flint Registry pet owners found that adults who drank unfiltered tap water were more likely to report Flint water made their pet ill than those who never did. Adults who said the water made their pet sick were more likely to report their own health and quality of life to be fair or poor compared to those who did not think their pets were sickened.
2024
Descriptive Analysis to Establish the Prevalence of Lead-Associated Chronic Conditions Among Adult Public Health Registry Participants in Flint, Michigan: Identifying Disparities to Support Focused Recovery Efforts
By Mohannad Yousef, Diana Haggerty, Nicole Jones, Jenny LaChance, Brittany Tayler, and Mona Hanna
BMJ Public Health
This study’s goal was to find the prevalence of 11 chronic conditions among Flint Registry adults and compare them to state-wide estimates. The Flint Registry adults had a higher prevalence of 9 of the conditions compared to the state. Causality can’t be known, but it is important to know how common such conditions are in the community so its health needs can be met.
The Impact of Community Engagement in the Design and Implementation of the Flint Registry
By Nicole Jones, Kenyatta Dotson, Kirk Smith, Lawrence Reynolds, Kent Key, and Mona Hanna-Attisha
Progress in Community Health Partnerships: Research, Education, and Action
This paper shares the Flint Registry’s strategy to include and elevate community voices in its design and work. Almost 1200 people and 7 funded organizations impacted 22 key areas. Community engagement may have built both trust and participation in the project. More than half of those who enrolled had heard about the Flint Registry through a community member.
REDCap to Epic Interfaces Create an Efficient Hybrid Software Solution for a Public Health Registry
By Marty Crawford, Nicole Jones, Jonathan Babbage, Morgan Edwards, Casey Bryson, and Mona Hanna-Attisha
Health Informatics Journal
The Flint Registry was created to track the long-term health of those impacted by the Flint water crisis and connect them to public health services. Since no software had all of the features to do this, the Flint Registry joined two programs to meet both community and project needs.
2023
Child Mental Health Status in Flint, Michigan: A Worsening Health Inequity, 2018-2022
By Jacqueline Dannis, Sarah Jenuwine, Nicole Jones, Jenny LaChance, and Mona Hanna-Attisha
American Journal of Public Health
To determine the burden of mental health disorders among children enrolled in Michigan’s Flint Registry in the context of a local public health crisis and a nationally declared pediatric mental health crisis.
2022
Parent Report of Child Behaviour: Findings from the Flint Registry Cohort
By Nicole Jones, Jacqueline Dannis, Lauren O’Connell, Jenny LaChance, Kaja LeWinn, and Mona Hanna-Attisha
Paediatric & Perinatal Epidemiology
When enrolling in the Flint Registry, parents complete a survey that helps identify children with potential behavioral and developmental concerns so they can be referred to diagnostic services. This study describes parent-reported behavioral outcomes of children (ages 2–17) who enrolled in the Flint Registry between December 2018 and December 2020. Although many children were identified as potentially at risk for behavior problems, the Flint Registry supports families by referring them to services that can help reduce the burden of such concerns.
2019
The Flint Water Crisis: A Coordinated Public Health Emergency Response and Recovery Initiative
By Perri Zeitz Ruckart, Adrienne S. Ettinger, Mona Hanna-Attisha, Nicole Jones, Stephanie I. Davis, and Patrick N. Breysse
Journal of Public Health Management and Practice
This practice report describes the emergency response to the Flint water crisis and highlights long-term recovery efforts, including the Flint Registry.