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OBJECTIVES: The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. METHODS: A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. RESULTS: In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. CONCLUSIONS: This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.
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Trastornos de la Visión , Humanos , Tennessee/epidemiología , Masculino , Femenino , Anciano , Estudios Transversales , Persona de Mediana Edad , Trastornos de la Visión/epidemiología , Factores de Riesgo , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anciano de 80 o más Años , Oftalmopatías/epidemiología , Encuestas y CuestionariosRESUMEN
In March 2021, grassroots leaders in two counties in northeast Tennessee formed a new network called Connections. Leaders are working to strengthen the capacity of the network and member organizations by promoting partnerships as vital to address effectively rural social determinants of health. Connections provides network members with capacity-building tools and resources, including two funding opportunities, to achieve their missions and sustain impact. Network members are also aligning around common goals to address the socioeconomic conditions affecting health outcomes. Connections will utilize findings from network activities and collaborations to identify synergies that can accelerate improvements in community health and well-being.
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Demographic aging is accelerating in the Appalachian Region, resulting in a growing proportion of caregivers living in areas that lack services to support their needs. Strategies are urgently needed in Appalachia to address deficiencies in the region's long-term supports and services for older adults and their caregivers. Strengthening equitable access to care and community supports for family caregivers is a policy priority for state and community leaders in Appalachia.
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OBJECTIVES: This study describes the changes in prevalence odds ratios (PORs) for Alzheimer disease (AD) in the northeast Tennessee region (NTR) during a 3-year period, describes the statistical assessment process, and critically assesses the database from which the statistical association was derived. The article also examines several beliefs pertinent to the clinical management of AD in the NTR from the perspective of professionals delivering services. METHODS: We extracted prevalence data for NTR counties for 2013, 2014, and 2015 from the Centers for Medicare & Medicaid Services Geographic Variation Public Use File. We used the crude prevalence and the 2010 US Census Data fixed population for each county to compute the POR. The 2013 Economic Research Service Rural-Urban Continuum Codes were used to identify rural and urban counties in the NTR. We collected primary data on the perceived observation of the increasing prevalence in the NTR during the last 3 years and barriers to early diagnosis through an online survey from 44 experts and professionals working in AD-related fields within the NTR. RESULTS: The PORs of AD in rural counties in NTR increased by 18.3%, 4.7%, and 19% compared with urban counties for 2013, 2014, and 2015, respectively. The POR of AD for the entire NTR region increased by 22.7%, 22.5%, and 21.2% compared with other regions in Tennessee for 2013, 2014, and 2015, respectively. Compared with 2012, 68.4% of respondents currently work with more individuals with AD; 71.8% reported that the NTR has a higher number of late-stage diagnoses of AD. A total of 92.3% strongly agreed that early detection of AD is important, and 95% agreed that early diagnosis could prolong the lives of patients with AD; 51.2% were unaware of existing AD screening services. Reported barriers were denial, lack of patient awareness, inefficient screening methods, communication, and lack of community resources. CONCLUSIONS: Increased prevalence of AD among inhabitants in the NTR and identified barriers to early screening or diagnosis in the management of AD were identified. Access to early screening techniques must be prioritized in deprived areas within the NTR. Healthcare providers and medical professionals in the NTR must be well equipped with the required training and resources to respond adequately to the increasing prevalence of AD.
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Enfermedad de Alzheimer/epidemiología , Anciano , Enfermedad de Alzheimer/diagnóstico , Diagnóstico Precoz , Femenino , Humanos , Masculino , Prevalencia , Tennessee/epidemiologíaRESUMEN
OBJECTIVE: Social support for physical activity (PA) has been shown to enhance PA levels in adolescents. Although social support has been examined extensively in the literature, less is known about the role of social support for PA for high school adolescents in rural southern Appalachia. PA is important because adolescent obesity is greater in Appalachia than in the rest of the United States. METHODS: This was a qualitative secondary analysis of focus groups conducted in 2013-2014 among parents, teachers, and high school students (N = 77) in 6 counties across rural southern Appalachia. Beets' typology of social support was used to categorize themes. RESULTS: Participants discussed instrumental supports, including providing transportation and paying fees, enrolling child in recreation/sports, and providing PA equipment at home. Performing PA with adolescents and modeling, watching/supervising, and prioritizing PA were identified as conditional supports. Several motivational supports were identified: encouragement, force, and the admiration of people who are active. Participants also identified key informational supports, including discussing the importance/health benefits of PA, how to be physically active, and general advice/information. Barriers to PA engagement (eg, body image issues, bullying, competitive nature of PA opportunities) and the role of referent groups (eg, family, peers, teachers) emerged as important concepts in the discussion. CONCLUSION: This study identifies opportunities and practical ways for families and schools to provide, build, and strengthen supports for PA among adolescents in rural Appalachia.
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Ejercicio Físico , Población Rural , Apoyo Social , Estudiantes , Adolescente , Adulto , Región de los Apalaches , Relaciones Familiares , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Motivación , Grupo Paritario , Deportes/economíaRESUMEN
Introduction: Diet and nutrition play an important role in a child's health and reduce the risk of numerous health problems including obesity. Dietary habits can be difficult to modify in children, particularly in Appalachia, where access to affordable, healthy foods is limited. Purpose: To examine barriers to healthy eating among Appalachian youth. Methods: In 2013-2014, data were gathered via focus groups and interviews from parents, school personnel, and adolescents (N=99) in six counties across southern Appalachia. Data were analyzed using thematic network analysis. Analysis was completed in 2015. Results: Participants identified multiple barriers to healthy eating among adolescents. Barriers comprised three global themes: cultural norms, school-based nutrition policy and programming, and rurality. Within the individual and home environment, beliefs and practices, time management, and preference for unhealthy foods affected adolescents' dietary behaviors. Schools faced challenges in terms of translating nutrition policy into practice, providing nutrition education, and engaging stakeholders. Limited socioeconomics and food deserts/swamps were community-level impacts. Implications: Participants discussed how adolescents' eating behaviors were shaped by social, physical, and environmental factors (e.g., cultural norms, school-based nutrition policy/programming, and rurality). These findings provide important insights into barriers to healthy eating in this population and point to future directions for research and practice. For example, the findings can be used by school personnel to develop ecologic approaches to school-based nutrition programming in Appalachia. Student associations can also use these findings to actively participate in efforts to improve school food offerings.
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Introduction: Social media have changed the landscape of health communication for nonprofit organizations (NPOs). Yet, adoption and use of social media lag among NPOs in rural Appalachia due largely to limited infrastructure development. Methods: Semi-structured phone interviews were conducted in January-March 2018 with 21 NPO representatives in an 8-county region of rural Appalachian Tennessee. NPO representatives were asked questions pertaining to social media use and message content, effective communication strategies, and best practices in social media use. Transcripts were analyzed in April-May 2018 using thematic analysis. Results: The majority of NPOs had a Facebook page and recognized its promise as a communication tool. However, due to resource constraints, most NPOs used social media as a secondary communication strategy to complement traditional approaches. In terms of messaging, NPOs used social media primarily to share information and solicit donations or volunteers. Representatives identified several obstacles to social media use among NPOs in the region. These included limited organizational resources, community infrastructure, and household resources. Implications: Social media are inexpensive communication tools that NPOs in rural Appalachia can use to expand their digital footprint into hard-to-reach populations. Therefore, eliminating the digital divide across the U.S. is an important step toward enhancing rural NPOs' capacity to serve their communities well. Opportunities for NPO staff to access low-cost professional development and training in the use of social media, specifically for social marketing purposes, are also essential.
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While partnerships for health delivery and improvement are frequently described by their structure, goals, and plans, less attention is paid to the interactive relationships among partners or for larger stakeholder groups' coalition memberships. The Give-Get Grid group process tool can be used to assess each stakeholders' expected benefits ("gets") and contributions ("gives") needed to establish and maintain long-term, mutually advantageous community-academic partnerships. This article describes three case study experiences using the Give-Get Grid in real-world context to understand and generate ideas to address contemporary health promotion opportunities among a variety of stakeholders. The case studies address three distinct community health promotion opportunities: prevention of school-based adolescent obesity disparities, higher education health professions training programs in rural community-based settings, and methods for engaging community coalitions in state Comprehensive Cancer Control Programs. The case studies demonstrate the Give-Get Grid's utility in both planning and evaluating partnerships and documenting key elements for progress in health promotion initiatives built on long-term community-academic relationships. Steps are explained with practical lessons learned in using the Grid.
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Relaciones Comunidad-Institución , Promoción de la Salud/organización & administración , Universidades/organización & administración , Adolescente , Investigación Participativa Basada en la Comunidad/métodos , Personal de Salud/educación , Disparidades en el Estado de Salud , Humanos , Estudios de Casos Organizacionales , Obesidad Infantil/prevención & control , Servicios de Salud Rural/organización & administración , Población Rural , Instituciones AcadémicasRESUMEN
Introduction There is limited research on the relation between weight misperceptions and health-related quality of life (HRQoL) among U.S. adolescents. Methods Baseline data (n = 1509) collected in 2012 from the Team Up for Healthy Living project were used. Measures included BMI percentiles calculated from measured height and weight; self-perception of weight status; and the 23-item PedsQL™ Inventory. Multiple linear regression was performed after adjustment for covariates to examine associations between weight misperception and HRQoL. Results Compared to accurate weight perception, weight underestimation was associated with higher total HRQoL (ß = 2.41), physical health (ß = 2.77), and emotional (ß = 2.83), social (ß = 2.47) and psychosocial functioning (ß = 2.38) (all p < 0.05). Weight overestimation was associated with lower social functioning (ß = -13.13, p < 0.05). Stratified by gender, associations were observed only in males. Discussion Weight underestimation had greater association with HRQoL than weight overestimation; and varied by gender. Better understanding of these associations will assist in improving the health of adolescents in Southern Appalachia.
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Peso Corporal , Obesidad Infantil/psicología , Calidad de Vida/psicología , Autoimagen , Adolescente , Región de los Apalaches , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Obesidad Infantil/complicacionesRESUMEN
OBJECTIVES: To develop a scale to assess infectious disease-specific health literacy (IDSHL) in China and test its initial psychometric properties. METHODS: Item pooling, reduction and assessment of psychometric properties were conducted. The scale was divided into 2 subscales; subscale 1 assessed an individual's skills to prevent/treat infectious diseases and subscale 2 assessed cognitive ability. In 2014, 9000 people aged 15-69â years were randomly sampled from 3 provinces and asked to complete the IDSHL questionnaire. Cronbach's α was calculated to assess reliability. Exploratory factor analysis, t-test, correlations, receiver operating characteristic (ROC) curve and logistic regression were used to examine validity. RESULTS: Each of the 22 items in subscale 1 had a content validity index >0.8. In total, 8858 people completed the scale. The principal components factor analysis suggested a 5-factor solution. All factor loadings were >0.40 (p<0.05). The IDSHL score was 22.07±7.91 (mean±SD; total score=38.62). Significant differences were observed across age (r=-0.276), sex (males: 21.65±8.03; females: 22.47±7.78), education (14.16±8.19 to 26.55±6.26), 2-week morbidity (present: 20.62±8.17, absent: 22.35±7.83; p<0.001) and health literacy of the highest and lowest 27% score groups (all p<0.05). The ROC curve indicated that 76.2% of respondents were adequate in IDSHL. Binary logistic regression analysis revealed 12 predictors of IDSHL adequacy (p<0.05). Among the 22 remaining items, Corrected Item-Total Correlation ranged from 0.316 to 0.504 and Cronbach's α values ranged from 0.754 to 0.810 if the items were deleted. The overall α value was 0.839 and the difficulty coefficient ranged from 1.19 to 4.08. For subscale 2, there were statistically significant differences between the mean scores of those with a correct/incorrect answer (all p<0.001). CONCLUSIONS: The newly developed 28-item scale provides an efficient, psychometrically sound and user-friendly measure of IDSHL in the Chinese population.
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Enfermedades Transmisibles/psicología , Alfabetización en Salud/normas , Adolescente , Adulto , Anciano , China , Cognición , Análisis Factorial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Psicometría/métodos , Curva ROC , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We examined associations between trait hope and preparation for future care needs (PFCN) among 66 older adult primary care patients in western New York. Participants completed a questionnaire assessing PFCN (awareness, information gathering, decision-making, concrete planning, and avoidance), and the Adult Trait Hope Scale. In multivariate regressions, lower hope, particularly less agency, was associated with more awareness of needing care, whereas higher hopefulness, particularly pathways thinking, was associated with increased decision-making and concrete planning. Greater hopefulness appears to be linked to goal-directed planning behaviors, although those with lower hope may actually be more aware of the need for planning. Evidence-based programming that encourages learned hopefulness may contribute to enhanced health planning and decision-making among older adult primary care patients.
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BACKGROUND: The psychosocial benefits of participating in physical activity (PA) are well known; less is known about the relationship between suicidal behaviors and PA among adolescents, especially among middle school-aged youth. This study seeks to fill that gap by assessing the cross-sectional relationship between these variables. METHODS: A secondary analysis of the 2010 Tennessee Middle School Youth Risk Behavior Survey data was conducted among 65,182 middle school students. Items examined were PA, sports team engagement, physical education (PE) class, screen time, suicidal behaviors, drug/substance use, extreme weight control behaviors, weight status and weight misperceptions, and selected personal characteristics. Multiple logistic regression analysis was used to estimate the association between PA, sports team engagement, and PE class attendance on suicidal behaviors. RESULTS: Sports team engagement was significantly associated with suicidal thoughts, plans, and attempts even after controlling for other important variables. There was no relationship, however, between total PA or PE class attendance in univariate or multivariate models, respectively. CONCLUSIONS: Findings suggest that sports team engagement is associated with reduced risk for suicidal thoughts, plans, and attempts, whereas, no relationships were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help clinicians screen for risk of suicidal behaviors.
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Ejercicio Físico/fisiología , Estudiantes/estadística & datos numéricos , Ideación Suicida , Peso Corporal , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Coordinated School Health (CSH) is a systematic approach to improving the health and well-being of school-age children. It is recommended for its potential to promote healthy weight in adolescents through strategic programming. Resources and programming for adolescent obesity prevention varies among schools, thereby limiting the intended benefits of CSH. The purpose of this study was to understand gaps in schools' approaches to healthy weight promotion and support for overweight/obese students. We evaluated perceptions of adolescent obesity and environmental factors and programs facilitating healthy weight in high schools in Appalachian Tennessee. METHODS: In 2012, 17 key school personnel from 5 randomly selected high schools were interviewed. Questions addressed their perceptions of adolescent obesity, school-based physical activity and nutrition programming, and support available to overweight/obese students. Thematic analysis was conducted to identify emerging themes. RESULTS: Participants consistently identified adolescent obesity and/or associated risk factors as major health problems within their schools. Barriers to physical activity and healthful eating were identified at multiple levels. Because of the sensitivity surrounding overweight/obesity, no particular programs or curricula targeted overweight/obese adolescents specifically, but they were available to all students. Support is not explicitly available; therefore, overweight/obese students must seek out these resources. CONCLUSIONS: Findings suggest that although school personnel are concerned about the impact of adolescent obesity on health outcomes, there is wide variation across schools on the types and quality of programming available to address the issue. Results can be used to encourage school-based strengths and identify gaps in the CSH infrastructure in school systems.
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Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Estudiantes/estadística & datos numéricos , Adolescente , Índice de Masa Corporal , Peso Corporal , Femenino , Humanos , Masculino , Sobrepeso/epidemiología , Sobrepeso/prevención & control , Factores de Riesgo , Servicios de Salud Escolar , Instituciones Académicas , Encuestas y Cuestionarios , Tennessee/epidemiologíaRESUMEN
The objective of this study was to examine weight status among southern Appalachian adolescents and to identify risk factors for obesity. We analyzed baseline data from the Team Up for Healthy Living study in 2012. Overall, 19.8% of the sample was overweight, and 26.6% was obese. Boys had higher rates of overweight/obesity than girls (50.5% vs 42.3%). Being male (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.39-2.29), having a mother with a high school education or less (OR = 1.39; 95% CI, 1.05-1.83), or having a father with a high school education or less (OR = 1.57; 95% CI, 1.17-2.09) was associated with a higher prevalence of obesity and a higher body mass index z score (ß = 0.131, 0.160, and 0.043, respectively, P < .05). Parental education could be used to identify adolescents with a higher likelihood of obesity.
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Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Adolescente , Región de los Apalaches/epidemiología , Índice de Masa Corporal , Análisis por Conglomerados , Escolaridad , Padre/educación , Padre/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Masculino , Madres/educación , Madres/estadística & datos numéricos , Oportunidad Relativa , Sobrepeso/etiología , Obesidad Infantil/etiología , Prevalencia , Factores de Riesgo , Factores Sexuales , Tennessee/epidemiologíaRESUMEN
OBJECTIVES: The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status. METHODS: Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys). RESULTS: The study revealed significant differences between the approaches to defining weight misperception (χ(2) = 16.2; P = 0.0003). CONCLUSIONS: Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception.