Introduction to the New “Early Reports of Innovation” Section

The Journal of Appalachian Health is introducing a new section this issue. While the journal is centralizing some of the best research and commentary on Appalachian health, the editorial team felt that practice-focused groups, organizations, and agencies may not be fully represented in the publication

Development and Early Outcomes of the Watauga Compassionate Community Initiative, North Carolina

Addressing adverse childhood experiences has become a public health imperative, and communities across the United States are working to develop and implement programs and policies to both prevent childhood trauma and support adults who experienced trauma as children. Here we describe the development of the Watauga Compassionate Community Initiative (WCCI) in Watauga, County, North Carolina

A Healthy Attitude: Rural Leaders in TN County Organize to Address Well-Being in Appalachia

When it came to formal philanthropy, Grundy County was not on the map. That changed with the 2012 establishment of South Cumberland Community Fund, which serves the plateau portions of Grundy, Franklin, and Marion counties

Association between low health literacy and adverse health behaviors in North Carolina, 2016

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health. Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health. Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18–49, 50–64, and 65–75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, -psacalc-, were used to examine the relationships by addressing omitted variable bias in OLS regressions. Results: Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years. Implications: The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted

Language Performance Of Individuals At Risk For Mild Cognitive Impairment

Evidence exists that changes in language performance may be an early indicator of mild cognitive impairment (MCI), often a harbinger of dementing disease. The purpose of this study was the evaluation of language performance in individuals at risk for MCI by virtue of age and self-concern and its relation to performance on tests of memory, visuospatial function, and mental status. Eighty-three individuals 55 years or older were administered the Arizona Battery for Communication Disorders of Dementia (Bayles & Tomoeda, 1993), a standardized battery with normative data from 86 healthy older adults (HOAs) and 86 individuals with Alzheimer's dementia, the most common dementing disease. A performance criterion of 1–1.5 SDs below the mean of HOAs defined MCI, as recommended in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We hypothesized that (a) the majority of at-risk participants would score 1 SD or more below the mean of HOAs on 1 or more subtests and (b) language performance tests would present a greater challenge than memory, mental status, and visuospatial construction tests. Both hypotheses were confirmed. Sixty-two participants (74.6%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria on at least 1 subtest. Moreover, language subtests were those most likely to elicit a performance 1 SD or more below the mean of HOAs. Language performance deficits can appear early before impairment in episodic memory, visuospatial construction ability, or mental status in individuals at risk for MCI. Speech-language pathologists are uniquely qualified to identify subtle changes in language, and standardized language tests with normative data should be used when testing for MCI

The Economic Value Of Informal Caregiving For Persons With Dementia: Results From 38 States, The District Of Columbia, And Puerto Rico, 2015 And 2016 BRFSS

Objectives. To estimate the economic value from a societal perspective of informal caregiving of persons with dementia in 38 states, the District of Columbia, and Puerto Rico. Methods. Using a cost replacement method and data from the 2015 and 2016 Behavioral Risk Factor Surveillance System caregiver module, the US Bureau of Labor Statistics May 2016 Occupation Profiles, and the US Department of Labor, we estimated the number and economic direct cost of caregiving hours. Results. An estimated 3.2 million dementia caregivers provided more than 4.1 billion hours of care, with an average of 1278 hours per caregiver. The median hourly value of dementia caregiving was $10.28. Overall, we valued these caregiving hours at$41.5 billion, with an average of $13069 per caregiver. Conclusions. Caregivers of persons with dementia provide care that has important economic implications. Without these efforts, many people would either not receive needed care or have to pay for that support. Surveillance data can be used to estimate the contributions of informal caregivers and the economic value of the care they provide

Lack Of Choice In Caregiving Decision And Caregiver Risk Of Stress, 2005

An aspect of caregiving that has received little attention is the degree to which the choice to provide care affects a caregiver's emotional well-being. We compared a population-based sample of informal caregivers who reported having a choice in caring with caregivers who did not have a choice in caring to determine the extent to which choice affects caregivers' self-reported stress. We identified 341 informal caregivers who completed a caregiving module appended to the 2005 North Carolina Behavioral Risk Factor Surveillance System survey. We determined participants' self-reported stress by using a 5-point scale that was dichotomized and used adjusted binomial logistic regression to assess the risk of stress given lack of choice in caregiving. In the fully adjusted model, caregivers without a choice in caring were more than 3 times as likely to report stress as caregivers with a choice in caring. High level of burden also increased stress. Caregivers with no choice in caring were most commonly the primary caregiver of a parent. Caregivers who do not have a choice in caregiving were at increased risk of stress, which may predispose them to poor health outcomes. Further investigation is needed to determine whether interventions that target caregivers without a choice in caring can reduce their levels of stress

The Cross-Sectional Association Between Severity Of Non-Cognitive Disability And Self-Reported Worsening Memory

Background: Research has demonstrated a clear association between cognitive decline and non-cognitive disability; however, all of these studies focus on disability as a correlate or result of some level of cognitive impairment or dysfunction. The relationship between disability and cognition is likely a complex one, that is currently incompletely described in the literature. Objectives: Our objective was to estimate the prevalence of long-term, non-cognitive disability using a population-representative sample of adults aged 18 and older, and then estimate the association between long-term, non-cognitive disability and self-reported worsening memory. Methods: Using the 2009 FloridaBehavioral Risk Factor Surveillance System (BRFSS), we measured the relationship between non-cognitive disability and worsening memory using multivariable logistic regression analysis weighted to account for the complex samplingdesign of the BRFSS. We also estimated the adjusted odds of worsening memory by disability severity, classified according to the types of assistance needed. Results: Approximately 18% (95% confidence interval = (16%, 19%)) of Floridians were living with a long-term, non-cognitive disability in 2009. Among adults with no disability during or prior to the last year, only 5% reported worsening memory. The proportion of Floridians reporting worsening memory increases with increasing severity of disability-related limitations. In a multivariable logistic regression model, odds of worsening memory increased significantly with severity of disability-related limitations. Conclusions: These results highlight the association between non-cognitive disability and subsequent increased odds of worsening memory, independent of several other known risk factors, and a dose-response association with disability-related limitations

Adult Informal Caregivers Reporting Financial Burden In Hawaii, Kansas, And Washington: Results From The 2007 Behavioral Risk Factor Surveillance System

Given the unpaid nature of the work, informal caregiving can create a financial burden for caregivers. Little has been done to identify specific predictors of experiencing financial burden. This study investigated demographic and health factors comparing caregivers who reported having or not having financial burden. Data are derived from adult caregivers (N = 3,317) as part of the 2007 Behavioral Risk Factor Surveillance System in Hawaii, Kansas, and Washington. The adjusted odds ratios for reporting a financial burden were estimated for demographic and other risk factors. Caregivers who reported a financial burden were younger, had lower incomes, were more likely to be current smokers, have had a stroke, and rate their health as fair or poor compared to caregivers who did not report a financial burden. Caregivers who were younger (ages 18-34), resided with care recipients, spent 20-39 hours per week providing care, and reported having a disability were at a statistically significantly higher odds of reporting a financial burden. Given the current economic difficulties faced by many Americans, further insights into the perceived financial burdens experienced by informal caregivers as well as linkages to policy and programs designed to support caregivers are critical for public health professionals to address the expanding needs in states and communities

The Intersection Of Public Health Data And Rehabilitation Practice

It is anticipated that the number of older adults with impairments or limitations will increase from approximately 14 million today to more than 28 million in 2030. The intent of this article is to illustrate the place of public health and population-level data in understanding current and future impacts on rehabilitation practitioners, the services they provide, and the clients they serve. Rehabilitation professionals can use public health data, like the Census and Behavioral Risk Factor Surveillance System, to facilitate data-driven planning. To explain this notion, we introduce basic public health concepts as well as aging and disability-related data examples