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The mental health consequences of the Covid-19 pandemic are particularly relevant in African American communities, as African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared to other racial groups. Using the state of Michigan as an example, we describe the social and psychological consequences of the pandemic on African-American communities in the United States, highlighting community members' concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already traumatized communities. Further, we describe the multi-level community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. Keywordscommunity mental health; trauma; racial disparities; coronavirus; population health African-American communities in the state of Michigan have been disproportionately impacted by the Covid-19 pandemic. Despite making up only 13% of Michigan's population, African-Americans account for 32% of confirmed cases and 41% of pandemic related-deaths (Michigan Department of Health and Human Services, 2020). In Michigan's primarily African-American communities, more than 10% of Covid-19 cases end in death (Michigan Department of Health and Human Services, 2020). A disease that was initially thought to mostly impact older adults and the chronically infirmed has now become a national scourge, devastating African-American communities across the U.S.From a mental health perspective, the pandemic has heightened fear in a segment of the population that already faces significant barriers to mental health treatment. Despite having rates of mental illness similar to Whites, African-Americans experience significant

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We examined the relationship between perceptions of household tap water quality and posttraumatic stress disorder (PTSD) symptoms during the Flint, Michigan, water crisis in 2015-2016. The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. Perceptions of household tap water quality was added to the 2015-2016 survey wave after inadequate official response to concerns over water quality after a change in Flint's municipal water supply. Respondents (N = 786) also completed a brief PTSD screening tool. We examined the relationships of perceived household tap water quality to PTSD symptomatology and positive screening criteria for PTSD, controlling for sociodemographics. Perceived tap water quality predicted PTSD symptomatology and positive screening criteria for PTSD, independent of sociodemo-

Engaging patients and communities is invaluable for achieving a patient-centered learning health system. Based on lessons learned in genomic and public health public engagement efforts of our community-based organizations in Flint, Michigan, we offer a continuum model for distinguishing various levels of community engagement and recommendations for approaching community, patient, and public engagement for health care systems that are expanding uses of health information. KEYWORDSCommunity engagement, learning health system, patient-centered health care, public engagement, Health Care in America, defines a learning health system (LHS) as a system "designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care." 1 Learning health system core values were developed to present a gold standard approach toward the mission of a national patient-centered LHS. 2 One core value is cooperative and participatory leadership, which ensures the participation/engagement of diverse communities and populations. 3 As LHS frameworks increasingly shape health information use in a variety of ways ranging from research to largescale quality improvement and to chronic disease management, there are abundant opportunities and challenges for engagement. A critical factor in a productive LHS is the engagement of patients, family members, and community. 3 The National Academy of Medicine posits engaged and empowered patients as a key characteristic of the LHS. 4 Understanding the optimal strategies for knowing when, how, and to what extent to engage the public will be critical to building meaningful relationships between health care systems and the communities they aim to serve. Notably, an important consideration is the cultural context within which these processes occur (Figure 1) as supported by the Institute of Medicine, National Academy of Medicine's table of characteristics of a LHS. It is also important to have a clear definition of "community" and shared definitions across communities that enable dialogue about the goals and activities of efforts, such as LHSs, toThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.