PROJECT SUMMARY Rationale: Residents of Flint, Michigan, a predominantly African American community, were directly harmed by exposure to lead-contaminated water after the state-appointed city manager switched the source of drinking water from the Detroit water system to the Flint River. However, the public health consequences of the Flint Water Crisis (FWC) may not be confined to Flint. Drawing on recent work that documents the health consequences of exposure to vicarious, or second-hand, racism, the proposed transdisciplinary, mixed- methods research will test the hypothesis that African American women in Michigan communities outside of Flint attribute the FWC to structural racism and that witnessing the effects of structural racism on members of their own racial/ethnic group in Flint negatively affected their well-being and the health of their offspring via stress-related mechanisms. Methods: We will utilize the cultural consensus methodology, a multi-phase and mixed-methods research approach, to address three aims. In Aim 1, we will conduct in-depth interviews and a focus group with key cultural informants to determine whether African American women of reproductive age in Ypsilanti, Michigan?a community 65 miles south of Flint that is similar with respect to size, racial/ethnic composition, and percent poverty?attribute the FWC to structural racism. In Aim 2, we will administer a quantitative survey to approximately 150 women of reproductive age in Ypsilanti to examine emotional reactions to the FWC and to identify coping resources used to manage the stress of the FWC. In Aim 3, we will use individual birth records linked to archived dried blood spots from the Michigan Neonatal Biobank to examine changes in birth outcomes (preterm birth and low birthweight) and biomarkers of stress and aging (telomere length and DNA methylation in the glucocorticoid receptor gene) among infants born to African American mothers in Ypsilanti and other Michigan communities outside of Flint after the FWC. Consistent with the principles of community- based participatory research, we will partner with our community advisory board to share the results of this research with survey respondents and other Ypsilanti community members through local presentations. Relevance: Disparities in maternal and child health are large and persistent, but they remain poorly understood. The proposed study will address a critical gap in the literature by examining vicarious structural racism as a mechanism underlying these disparities, with a focus on the consequences of indirect exposure to the FWC for the health of women and infants in Michigan. By identifying multi-level sources of resilience to vicarious structural racism, the proposed study will provide information necessary for the development of evidence-based policies and interventions to reduce the harmful intergenerational effects of vicarious structural racism on the health of African Americans in the US.