Perceived Threat of Alzheimer's Disease and Help-seeking Behavior in Older Adults with Memory Complaints

Alzheimer’s disease (AD) is a chronic disorder with a high burden of suffering for affected individuals, their caregivers, families, and communities. An increased emphasis on early AD detection may benefit affected individuals and their caregivers, especially where disparities already exist in health care and outcomes, but may also unnecessarily heighten perceived AD threat among healthy older adults. Relatively few studies have examined predictors of perceived AD threat and help-seeking behavior among a large and diverse sample that is broadly representative of the U.S. adult population. Informed by health behavior theory, my dissertation 1) identifies factors that influence formal help-seeking for memory complaints through a systematic review of the literature, 2) examines psychosocial and cognitive predictors of perceived AD threat, an understudied construct related to help-seeking, among a nationally representative sample of U.S. adults from the Health and Retirement Study, and 3) explores demographic, health care access, and health status predictors of help-seeking among older adults with memory complaints using Behavioral Risk Factor Surveillance System data. Findings from the systematic review suggest that individual, interpersonal, and structural/policy level factors each play a key role in help-seeking. Multivariate analyses of perceived AD threat revealed that perceived threat was significantly higher for respondents aged 50-64 and 65-74 than for those over 75. Higher perceived threat was also associated with a family history of AD (compared to no experience), stronger beliefs that stress or genetics are important AD risk factors, more depressive symptoms, poorer self-rated memory, and lower cognitive function. Respondents with lower education levels were significantly less likely to seek help. Those who reported more memory-related functional difficulty, more frequent days of poor mental health, and having a primary care provider, were more likely to seek help. These findings highlight the need for education and community outreach to raise awareness about early dementia symptoms, provide specific factors that health care providers should consider in clinical encounters, and highlight the need for careful initial cognitive screening of individuals with memory complaints. These findings also provide insight about the help-seeking process, and a starting point for interventions aimed at increasing timely AD diagnosis and treatment.PHDHealth Behavior & Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/136998/1/jeosterg_1.pd

Better Kid Care Program Improves the Quality of Child Care: Results from an Interview Study

More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2 months post-program, most participants could name specific skills or knowledge they learned and improvements they made in their early childhood programs as a result of BKC. The BKC program improves child care quality, and increasing program participation is recommended

Diet and exercise changes following direct-to-consumer personal genomic testing

Background: The impacts of direct-to-consumer personal genomic testing (PGT) on health behaviors such as diet and exercise are poorly understood. Our investigation aimed to evaluate diet and exercise changes following PGT and to determine if changes were associated with genetic test results obtained from PGT. Methods: Customers of 23andMe and Pathway Genomics completed a web-based survey prior to receiving PGT results (baseline) and 6 months post-results. Fruit and vegetable intake (servings/day), and light, vigorous and strength exercise frequency (days/week) were assessed. Changes in diet and exercise were examined using paired t-tests and linear regressions. Additional analyses examined whether outcomes differed by baseline self-reported health (SRH) or content of PGT results. Results: Longitudinal data were available for 1,002 participants. Significant increases were observed for vegetable intake (mean Δ = 0.11 (95% CI = 0.05, 0.17), p = 0.0003) and strength exercise (Δ = 0.14 (0.03, 0.25), p = 0.0153). When stratified by SRH, significant increases were observed for all outcomes among lower SRH participants: fruit intake, Δ = 0.11 (0.02, 0.21), p = 0.0148; vegetable intake, Δ = 0.16 (0.07, 0.25), p = 0.0005; light exercise, Δ = 0.25 (0.03, 0.47), p = 0.0263; vigorous exercise, Δ = 0.23 (0.06, 0.41), p = 0.0097; strength exercise, Δ = 0.19 (0.01, 0.37), p = 0.0369. A significant change among higher SRH participants was only observed for light exercise, and in the opposite direction: Δ = -0.2468 (-0.06, -0.44), p = 0.0111. Genetic results were not consistently associated with any diet or exercise changes. Conclusions: The experience of PGT was associated with modest, mostly positive changes in diet and exercise. Associations were independent of genetic results from PGT

“Why did I get that part of you?” Understanding addiction genetics through family history

Scientists have sought to uncover the genetic bases of many diseases and disorders. In response, scholars defined "geneticization" to describe genetic infiltration of understandings of health and illness. In our research, we interviewed 63 individuals in addiction treatment programs to identify what form of geneticization best fits individuals' description of their own addiction. Individuals' narratives of their lives, which include family history and are influenced by cultural and structural factors, affect respondents' reactions to a potential genetic basis of addiction. Most who had a family history of addiction subscribed to a notion that addiction "runs in families," while most who lacked a family history of addiction used this fact to reject the notion of genetic inheritance of addiction. We conclude that though we see elements of several different versions of geneticization, Nikolas Rose's version, that genetics affects peoples' perceptions of addiction in small but important ways, best describes our respondents' views

“I don’t have to know why it snows, I just have to shovel it!”: Addiction recovery, genetic frameworks, and biological citizenship

The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals' understanding of their own health as it relates to a behavioral trait, like addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology

Challenges in translational research: the views of addiction scientists.

OBJECTIVES: To explore scientists' perspectives on the challenges and pressures of translating research findings into clinical practice and public health policy. METHODS: We conducted semi-structured interviews with a purposive sample of 20 leading scientists engaged in genetic research on addiction. We asked participants for their views on how their own research translates, how genetic research addresses addiction as a public health problem and how it may affect the public's view of addiction. RESULTS: Most scientists described a direct translational route for their research, positing that their research will have significant societal benefits, leading to advances in treatment and novel prevention strategies. However, scientists also pointed to the inherent pressures they feel to quickly translate their research findings into actual clinical or public health use. They stressed the importance of allowing the scientific process to play out, voicing ambivalence about the recent push to speed translation. CONCLUSIONS: High expectations have been raised that biomedical science will lead to new prevention and treatment modalities, exerting pressure on scientists. Our data suggest that scientists feel caught in the push for immediate applications. This overemphasis on rapid translation can lead to technologies and applications being rushed into use without critical evaluation of ethical, policy, and social implications, and without balancing their value compared to public health policies and interventions currently in place

O3‐11‐06: Who’s Afraid of Alzheimer’s Disease? The Influence of Psychosocial and Cognitive Factors on the Perceived threat of Alzheimer’s Disease among a Representative Sample of U.S. Adults

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152880/1/alzjjalz201606572.pd

Description of Sample (N = 20).

<p>Description of Sample (N = 20).</p