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Approximately 20% of U.S. adults are unpaid caregivers (caregivers) (1) who provide support to a family member or friend with a health condition or disability. Although there are benefits to caregiving, it can negatively affect caregivers' physical and mental health (2-4). Much of the assistance caregivers provide, such as administering medications or financial management, relies on cognitive ability, but little is known about caregivers' cognitive functioning. Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss over the past year (5), could affect caregivers' risk for adverse health outcomes and affect the quality of care they provide. CDC analyzed SCD among caregivers aged ≥45 years through a cross-sectional analysis of data from 22 states in the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). Among adults aged ≥45 years, SCD was reported by 12.6% of caregivers who provided care to a family member or friend with a health condition or disability in the past 30 days compared with 10.2% of noncaregivers (p

Multiple chronic conditions (MCC) reduce quality of life and are associated with high per capita health care spending. One potential way to reduce Medicare spending for MCC is to identify counties whose populations have high levels of spending compared to level of disease burden. Using a nationally representative sample of Medicare Fee-for-Service beneficiaries, this paper presents a method to measure the collective burden of several chronic conditions in a population, which the authors have termed the concentration of chronic conditions (CCC). The authors observed a significantly positive linear relationship between the CCC measure and county-level per capita Medicare spending. This area-level measure can be operationalized to identify counties that might benefit from targeted efforts designed to optimally manage and prevent chronic illness.

In 2015, an estimated 17.7 million U.S. persons were informal caregivers who provided substantial services through in-home, unpaid assistance to their family members and friends (1). Caregiving can have many benefits, such as enhancing the bond between caregiver and recipient, but it can also place an emotional and physical strain on caregivers, leading to higher rates of depression, lower quality of life, and poorer overall health (2). As the U.S. population continues to age (3), the need for informal caregivers will likely increase. However, little nationally representative information on prevalence of caregivers is available. This study examined demographic characteristics and health status of informal caregivers from 44 states,* the District of Columbia (DC), and Puerto Rico, based on data from the Behavioral Risk Factor Surveillance System (BRFSS) collected during 2015-2017. Overall, approximately one in five adults reported that they had provided care to a family member or friend in the preceding 30 days. Fifty-eight percent of caregivers were women, and a majority were non-Hispanic white, with at least some college education, and married or living with a partner. Across all states, 19.2% of caregivers reported being in fair or poor health, although significant state-to-state variation occurred. Caregivers provide important support to family members, friends, and the health care system and might compromise their own health to provide this support (1,2). Better understanding of caregivers and the challenges they face could inform implementation of improvements in support systems that could enhance not only the health of the caregiver, but that of the care recipient as well. For example, additional data regarding demographics at the state level might aid in more effective planning and support of caregivers with evidence-based programs and assistance (https://www.cdc.gov/aging/publications/features/caring-for-yourself.html).

Introduction Subjective cognitive decline (SCD) represents self‐reported problems with memory, a possible early sign of dementia. Little is known about SCD among sexual and gender minority (SGM) adults who identify as lesbian, gay, bisexual, and/or transgender or gender non‐binary. Methods Data were weighted to represent population estimates from 25 states’ 2015–2018 Behavioral Risk Factor Surveillance System to describe SCD in adults ≥45 years by SGM status. Logistic regression tested associations between demographic and health conditions. Results SCD prevalence was higher in SGM (15.7%; 95% confidence interval [CI]:13.1–18.2) than in non‐SGM adults (10.5%; 95% CI:10.1–10.9; P

Background Emergencies and disasters can exacerbate or complicate unique vulnerabilities associated with dementia The Healthy Brain Initiative?s State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map calls for addressing the special needs of people with dementia and caregivers in emergency preparedness/response Method During the coronavirus (COVID-19) pandemic, public health professionals play a critical role in protecting people living with dementia, their caregivers and families The Alzheimer's Association and the Centers for Disease Control and Prevention (CDC) educated public health professionals and partners about the unique challenges associated with dementia during the pandemic and steps to tailor the emergency response Homes in the community, acute care and long-term care are three settings that require unique public health responses Result Challenges encountered vary by setting In homes and the community, people living with dementia and their caregivers have been affected by the suspension of adult day services, social events, congregate meals, respite care, peer support groups, community education, physical activity classes and more, including virtual delivery of non-urgent primary care, case management and behavioral health Many emergency departments and hospitals adopted no-visitor policies to reduce transmission of COVID-19;however, caregivers for people living with dementia provide essential medical and emotional support that aids diagnosis and treatment Long-term care (LTC) facilities are especially prone to COVID-19 outbreaks due to the concentration of vulnerable older adults, many with some form of cognitive impairment Provision of person-centered dementia care is hampered by no-visitor policies without caregiver allowances and limited training of professionals working in LTC facilities during the crisis Conclusion Taking immediate public health actions will not only help minimize the negative impacts of COVID-19 on people living with dementia and their caregivers, but also support effective, efficient delivery of person-centered care Through this session, public health professionals will quickly learn about challenges posed by dementia in these settings, immediate steps to better protect health and safety for this population, and resources their departments can use Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC

Objectives:To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL).Design:Cross-sectionalSetting:US – 50 states, District of Columbia, and Puerto RicoParticipants:Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015-–2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568).Measurements:We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted.Results:In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12–2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs.Conclusions:Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

Background and Objectives Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss, may be associated with the development or worsening of chronic conditions or complicating their self-management. The objectives of this study were to (i) establish the prevalence of chronic conditions and multiple chronic conditions among adults with SCD, and (ii) compare the prevalence of chronic conditions among people with and without SCD and SCD-related functional limitations. Research Design and Methods Data were analyzed from the Cognitive Decline module of the Behavioral Risk Factor Surveillance System administered in 49 states, DC, and Puerto Rico during 2015–2017. Analyses included 220,221 respondents aged 45 years or older who answered the SCD screening question and reported their chronic conditions. Weighted estimates were calculated and chi-square tests were used for comparisons. Results Persons with a history of stroke, heart disease, and chronic obstructive pulmonary disorder had significantly higher prevalence of SCD compared to those without. The prevalence of having at least one chronic condition was higher among adults with SCD compared to adults without SCD in each age group (45–64 years: 77.4% vs 47.1%, p < .001; ≥65 years: 86.3% vs 73.5%, p < .001). Among those with SCD, the prevalence of an SCD-related functional limitation was higher among those with at least one chronic condition compared to those with none (45–64 years: 63.3% vs 42.4%, p < .001; ≥65 years: 40.0% vs 25.1%, p < .001). Only half of adults with SCD and a chronic condition had discussed their SCD with a health care professional. Discussion and Implications SCD and chronic conditions commonly co-occur. Having a chronic condition was associated with greater SCD-related functional limitations. SCD might complicate the management of chronic conditions, and patients and providers should be aware of increased risk for cognitive decline in the presence of chronic diseases.

Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months (1,2) and one of the earliest noticeable symptoms of Alzheimer's disease (Alzheimer's), a fatal form of dementia (i.e., a decline in mental abilities severe enough to interfere with everyday life) (1). Alzheimer's is the most common form of dementia, although not all memory loss results from Alzheimer's (3). To examine SCD, CDC analyzed combined data from the 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Overall, 11.2% of adults aged ≥45 years reported having SCD, 50.6% of whom reported SCD-related functional limitations. Among persons living alone aged ≥45 years, 13.8% reported SCD; among persons with any chronic disease, 15.2% reported SCD. Adults should discuss confusion or memory loss with a health care professional who can assess cognitive decline and address possible treatments and issues related to chronic disease management, medical care, and caregiving.

Purpose To assess whether financial or health-related barriers were more common among rural caregivers and whether rural caregivers experienced more caregiving-related difficulties than their urban peers. Methods We used data from 7,436 respondents to the Caregiver Module in 10 states from the 2011-2013 Behavioral Risk Factor Surveillance System. Respondents were classified as caregivers if they reported providing care to a family member or friend because of a long-term illness or disability. We classified respondents as living in a rural area if they lived outside of a Metropolitan Statistical Area (MSA). We defined a financial barrier as having an annual household income

Alzheimer's disease (Alzheimer's), an ultimately fatal form of dementia, is the sixth leading cause of death in the United States, accounting for 3.6% of all deaths in 2014 (1,2). Alzheimer's deaths can be an indicator of paid and unpaid caregiver burden because nearly everyone in the final stages of Alzheimer's needs constant care, regardless of the setting, as the result of functional and cognitive declines (2). To examine deaths with Alzheimer's as the underlying cause, state-level and county-level death certificate data from the National Vital Statistics System for the period 1999-2014 were analyzed. A total of 93,541 Alzheimer's deaths occurred in the United States in 2014 at an age-adjusted (to the 2000 standard population) rate of 25.4 deaths per 100,000 population, a 54.5% increase compared with the 1999 rate of 16.5 deaths per 100,000. Most deaths occurred in a nursing home or long-term care facility. The percentage of Alzheimer's decedents who died in a medical facility (e.g., hospital) declined from 14.7% in 1999 to 6.6% in 2014, whereas the percentage who died at home increased from 13.9% in 1999 to 24.9% in 2014. Significant increases in Alzheimer's deaths coupled with an increase in the number of persons with Alzheimer's dying at home have likely added to the burden on family members or other unpaid caregivers. Caregivers might benefit from interventions such as education, respite care, and case management that can lessen the potential burden of caregiving and can improve the care received by persons with Alzheimer's.

Achieving meaningful progress against Alzheimer’s disease and related dementias (ADRD) requires an urgent public health response. Since 2005, the Alzheimer’s Association, Centers for Disease Control and Prevention (CDC), and other public health partners collaborated on the Healthy Brain Initiative (HBI). HBI seeks to advance public health awareness of and action on ADRD as a public health issue. The HBI Road Map Series, State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map (S&L RM) and Road Map for Indian Country, provide the public health with concrete steps to respond to the growing burden of ADRD in communities, consistent with the aim of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406). This series of RMs for state, local, and tribal public health provide flexible menus of actions to address cognitive health, including ADRD, and support for dementia caregivers with population-based approaches. The purpose of this session is to illustrate public health’s role with ADRD—past, present, and future. An overview of the evolution of HBI RM series will be provided (McGuire) and preliminary evaluation data of 24 actions from S&L RM will be presented (French, Shean, Beatty). Holt, Reed, & McGuire will share lessons learned and next steps from CDC’s Regional Action Institutes designed to facilitate implementation of the RM series across the US. The intersection between the RM series and Age-Friendly Public Health Systems will be described as a starting point for public health (Wolfe, French, Shean).

Purpose:Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians’ personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians’ SSB-related counseling practices and their personal and medical practice characteristics.Design:Cross-sectional survey.Setting:DocStyles survey, 2014.Participants:A total of 1510 practicing US physicians.Measures:Physician’s SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral.Analysis:Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician’s personal and medical practice characteristics.Results:Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68).Conclusion:Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.

Menu labeling can help people select foods and beverages with fewer calories and is a potential population-based strategy to reduce obesity and diet-related chronic diseases in the United States.The aim of this cross-sectional study was to examine the prevalence of menu-labeling use among adults and its association with sociodemographic, behavioral, and policy factors.The 2012 Behavioral Risk Factor Surveillance System data from 17 states, which included 100,141 adults who noticed menu labeling at fast-food or chain restaurants ("When calorie information is available in the restaurant, how often does this information help you decide what to order?") were used. Menu-labeling use was categorized as frequent (always/most of the time), moderate (half the time/sometimes), and never. Multinomial logistic regression was used to examine associations among sociodemographic, behavioral, and policy factors with menu-labeling use.Overall, of adults who noticed menu labeling, 25.6% reported frequent use of menu labeling, 31.6% reported moderate use, and 42.7% reported that they never use menu labeling. Compared with never users, frequent users were significantly more likely to be younger, female, nonwhite, more educated, high-income, adults who were overweight or obese, physically active, former- or never-smokers, less than daily (1 time/day) consumers of sugar-sweetened beverage, and living in states where menu-labeling legislation was enacted or proposed.Menu labeling is one method that consumers can use to help reduce their calorie consumption from restaurants. These findings can be used to develop targeted interventions to increase menu-labeling use among subpopulations with lower use.

Alzheimer’s disease and related dementias (ADRD) are a significant public health burden. Collectively, ADRD have been called the most expensive chronic conditions in the United States due to outsized health care utilization. Data from the 2016 and 2017 Healthcare Cost Utilization Project National Inpatient Sample, an all-payer representative sample of US hospitalizations, were used to describe hospitalizations in adults ≥65 years with ADRD. Chronic conditions were defined using International Classification of Disease, Tenth Edition, Clinical Modification (ICD-10-CM) code definitions from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. Code definitions from the Agency for Healthcare Research and Quality defined potentially preventable hospitalizations where admission might have been avoided by appropriate outpatient primary care management. One in six hospitalizations in adults ≥65 years were for persons with ADRD, including 1 in 3 adults ≥85 years. Among those with ADRD-related admissions, the most common reasons for admission, as defined by the principal diagnosis, were heart disease (18.1%), certain infections (14.5%), injuries (12.7%), respiratory illness (11.2%), and genitourinary conditions (10.4%). In hospitalized adults with ADRD, the prevalence of diagnosed urinary tract infection (37.0%)—a potentially preventable hospitalization—is more than double the prevalence in adults without ADRD (15.5%, prevalence ratio = 2.39, 95% confidence interval: 2.37-2.42). Common comorbidities, injuries, and potentially preventable hospitalizations all contribute to hospitalizations in adults with ADRD. Focusing on injury prevention and appropriate outpatient management of comorbidities in adults with ADRD might reduce the number of hospitalizations, including potentially preventable hospitalizations, among adults with ADRD.

As the US population ages, older adults will not only increasingly need assistance but also provide informal care to others. Our aims were to assess the prevalence and types of care provided by community-dwelling older adults. We used data from adults aged ≥60 years from 38 states, the District of Columbia, and Puerto Rico that included the Caregiver Module on the 2015 or 2016 Behavioral Risk Factor Surveillance System, representative telephone survey. Respondents who said they had provided any care or assistance to a friend or family member with a long-term illness or disability during the past month were classified as caregivers. We calculated weighted proportions. Among 112,848 respondents age ≥60, 20.0% were caregivers, including 22.7% of adults age 60–69, 18.8% of adults age 70–79, and 13.6% of adults age 80 or older. Regardless of age group, half of these caregivers assisted with personal care (range: 49.5% of caregivers age ≥80 to 51.1% of caregivers age 60–69) and nearly three-quarters assisted with household tasks (range: 70.9% of caregivers age ≥80 to 78.8% of caregivers age 60–69). Many caregivers had multiple chronic conditions themselves: 33.6% of 60–69 year olds, 42.7% of 70–79 year olds, and 48.6% of caregivers age 80 or older. One in five US adults ≥60 is a caregiver and older adults who serve as caregivers in the community perform intense tasks and spend substantial amounts of time providing care. Supports must be in place to enable these older adults to continue providing care and manage their own health.

Caregiving is an important public health issue that has not received adequate attention. Older adults with a cognitive impairment, overtime, increasingly need the assistance of caregivers. The Alzheimer’s Association and the Centers for Disease Control and Prevention’s (CDC) Alzheimer’s Disease and Healthy Aging Program, The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013–2018 (HBI RM), recognized the value of caregivers, but included only a few action items specific to this group of essential care providers. In the newly released 3rd Healthy Brain Initiative Road Map (3rd HBI RM), there is increased emphasis on caregiving. Of the 25-item Action Agenda, 17 relate to caregivers or their role. This presentation will describe how public health can be instrumental in acknowledging and supporting these unpaid caregivers, particularly those who provide care for people with Alzheimer’s or other dementias within the context of 3rd HBI RM.

Healthy aging is not merely the absence of disease or disability, but requires physical and mental health and ongoing social engagement (1). As the average U.S. life expectancy increases, recognition that public health can play a vital role in promoting healthy, successful aging even in the face of increased prevalence of chronic diseases, including types of dementia, among older adults (i.e., aged ≥65 years) has grown. Furthermore, actively engaging adults in prevention and wellness along with involving their caregivers (i.e., the family and friends of older adults who provide them with unpaid and informal support and services) can serve to prevent or delay the onset of physical disabilities and cognitive decline. Adults often are reluctant to discuss their concerns about worsening memory with their health care providers although such discussions can lead to earlier diagnosis and better care, planning, and support. As advances in public health and health care have helped increase life expectancy, public health professionals and health care providers have the opportunity to improve the quality of life for older adults and their caregivers and reduce the burdens associated with aging.

Introduction Alzheimer's disease and related dementias (ADRD) cause a high burden of morbidity and mortality in the United States. Age, race, and ethnicity are important risk factors for ADRD. Methods We estimated the future US burden of ADRD by age, sex, and race and ethnicity by applying subgroup-specific prevalence among Medicare Fee-for-Service beneficiaries aged ≥65 years in 2014 to subgroup-specific population estimates for 2014 and population projection data from the United States Census Bureau for 2015 to 2060. Results The burden of ADRD in 2014 was an estimated 5.0 million adults aged ≥65 years or 1.6% of the population, and there are significant disparities in ADRD prevalence among population subgroups defined by race and ethnicity. ADRD burden will double to 3.3% by 2060 when 13.9 million Americans are projected to have the disease. Discussion These estimates can be used to guide planning and interventions related to caring for the ADRD population and supporting caregivers.

Background Social gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer’s disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer’s disease risk. Methods Using data from the cross-sectional 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey, we tested for the association between U.S. state-level income inequality and individual SEP on subjective cognitive decline (SCD) – a marker of dementia risk – using a generalized estimating equation and clustering by state. Results State income inequality was not significantly associated with SCD in our multivariable model (OR 1.2; 95% CI: 0.9, 1.6; p=0.49). We observed a clear linear relationship between household income and SCD where those with an annual household income of 50k to 75k had 1.4 (95% CI: 1.3, 1.6) times the odds and those with household incomes of less than $10,000 had 4.7 (95% CI: 3.8, 5.7) times the odds of SCD compared to those with household income of more than $75,000. We also found that college graduates (ref.) and those who completed high school (OR: 1.1; 95% CI 1.04, 1.2) fared better than those with some college (OR: 1.3, 95% CI 1.2, 1.4) or less than a high school degree (OR: 1.5; 95% CI: 1.4, 1.7). Conclusions Income inequality does not play a dominant role in SCD, though a social gradient in individual income for SCD suggests the relationship may operate in part via status anxiety., Highlights • Research suggests education impacts cognitive decline via cognitive stimulation • Associations with income and inequality may suggest a “status anxiety” mechanism • Income inequality was not statistically associated with cognitive decline • We found a dose-response effect of individual income on cognitive decline • Status anxiety may contribute to disparities in dementia risk

While adults aged 65 years and older are most at risk for chronic conditions, studies show that middle-aged adults aged 45–64 years also have growing numbers of comorbid chronic diseases. Regardless of age, managing chronic conditions requires decision-making abilities to manage treatments effectively. Symptoms of memory loss and confusion may impair a person’s ability to manage their health. This study examined chronic conditions in persons with subjective cognitive decline (SCD), defined as the self-reported experience of increased memory problems or confusion. Behavioral Risk Factor Surveillance System data from 2015–2017 were used to define SCD and disease status for eight chronic conditions (heart disease, stroke, cancer, arthritis, asthma, depression, diabetes, and chronic obstructive pulmonary disease) for adults 45–64 years from 49 states, District of Columbia, and Puerto Rico that collected data on cognitive decline. Among adults aged 45–64 years, 10.8% reported SCD. Among those with SCD, 77.4% had at least one chronic disease compared to 47.1% of those without SCD. Those with SCD had a higher prevalence for all eight conditions compared to those similarly-aged without SCD. Adults with at least one chronic condition were more likely to discuss their symptoms of SCD with a health care professional (54.2%) compared to those with no chronic conditions (30.3%). Poor management of chronic conditions can result in increased health care costs and might worsen existing symptoms of confusion and memory problems. Self-care interventions for chronic disease management should consider the importance of an individual’s cognitive status, including SCD.

Summary Background Understanding state/territorial trends in obesity by race/ethnicity helps focus resources on populations at risk. Objective This study aimed to examine trends in obesity prevalence among low-income, preschool-aged children from 2008 through 2011 in U.S. states and territories by race/ethnicity. Methods We used measured weight and height records of 11.1 million children aged 2–4 years who participated in federally funded health and nutrition programmes in 40 states, the District of Columbia and two U.S. territories. We used logistic regression to examine obesity prevalence trends, controlling for age and sex. Results From 2008 through 2011, the aggregated obesity prevalence declined among all racial/ethnic groups (decreased by 0.4–0.9%) except American Indians/Alaska Natives (AI/ANs); the largest decrease was among Asians/Pacific Islanders (A/PIs). Declines were significant among non-Hispanic whites in 14 states, non-Hispanic blacks in seven states/territories, Hispanics in 13 states, A/PIs in five states and AI/ANs in one state. Increases were significant among non-Hispanic whites in four states, non-Hispanic blacks in three states, Hispanics in two states and A/PIs in one state. The majority of the states/territories had no change in obesity prevalence. Conclusions Our findings indicate slight reductions in obesity prevalence and variations in obesity trends, but disparities exist for some states and racial/ethnic groups.

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the "ABCDs" of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public-private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems.

Public health surveillance data are important as they can inform policymakers and health professionals on the current status of conditions, behaviors, and risk factors in a population. The Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion has developed the Healthy Aging Data Portal. This free, publicly accessible online resource provides access to a range of national, regional, and state data on the health of older adults. Users can examine data on indicators such as nutrition and physical activity, screenings and vaccinations, tobacco and alcohol use, and mental and cognitive health.

To describe aerobic physical activity among middle-aged and older adults by their selfreported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity. Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System. Landline and cellular telephone survey. 93,082 respondents aged 45 years and older from 21 US states in 2011. Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates. 12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care. Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.

As caregiving is becoming a leading public health issue, we used the BRFSS to better understand who caregivers are as well as features of their caregiving experience. We combined BRFSS data from three years (2015-2017) to examine demographic characteristics including gender, race, age, education, employment, and marital status. Slightly more than one in five BRFSS respondents (20.7%) were caregivers. The majority were women, had at least some college, were employed, and married or living with a partner. Most caregivers were under 45 years old, but a substantial proportion (20.7%) were 65 years or older. There was significant state variation by every demographic characteristic. These data underscore that caregiving is a common feature of U.S. family life, and caregivers’ concerns should be considered in healthcare, employment, and service provision. Important state-level variations uncovered by use of the BRFSS Caregiving Module could lead to better targeting of caregiver support programs.

Sugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association.We analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥18years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none,1 time/day, once/day, ≥2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier.Overall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥2 times/day. There was no difference in asthma prevalence with SSB intake1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥2 times/day (aOR=1.66, 95%CI=1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults.Frequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults.

Problem Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 3.5 million patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N = 300,667) or were treated and released from emergency departments (EDs; N = 2,077,350), outpatient departments (ODs; N = 83,857), and office-based physicians (OB-P; N = 1,079,338). In addition, 52,695 died with one or more TBI-related diagnoses. Methods Federal TBI-related laws that have guided CDC since 1996 were reviewed. Trends in TBI were obtained by analyzing data from nationally representative surveys conducted by the National Center for Health Statistics (NCHS). Findings CDC has developed and is implementing a strategy to reduce the burden of TBI in the United States. Currently, 20 states have TBI surveillance and prevention systems. From 1995–2009, the TBI rates per 100,000 population increased in EDs (434.1 vs. 686.0) and OB-Ps (234.6 vs. 352.3); and decreased in ODs (42.6 vs. 28.1) and in TBI-related deaths (19.9 vs. 16.6). TBI Hospitalizations decreased from 95.5 in 1995 to 77.9 in 2000 and increased to 95.7 in 2009. Conclusions The rates of TBI have increased since 1995 for ED and PO visits. To reduce of the burden and mitigate the impact of TBI in the United States, an improved state- and territory-specific TBI surveillance system that accurately measures burden and includes information on the acute and long-term outcomes of TBI is needed.

Introduction: Traumatic brain injury (TBI) can be complicated among older adults due to age-related frailty, a greater prevalence of chronic conditions and the use of anticoagulants. We conducted this study using the latest available, nationally-representative emergency department (ED) data to characterize visits for TBI among older adults. Methods: We used the 2006-2008 National Hospital Ambulatory Medical Care – Emergency Department (NHAMCS-ED) data to examine ED visits for TBI among older adults. Population-level estimates of triage immediacy, receipt of a head computed tomography (CT) and/or head magnetic resonance imaging (MRI), and hospital admission by type were used to characterize 1,561 sample visits, stratified by age

Background 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. Methods 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. Results 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. Conclusions/Implications 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 associations between serious psychological distress (SPD), chronic health conditions, healthy behaviors, healthy weight, and use of preventive services were examined among adults 65 years old and older using the 2007 Behavioral Risk Factor Surveillance System (BRFSS).Participants (N = 35,845) completed a scale of nonspecific psychological distress for the past 30 days. Chronic health conditions were investigated in addition to having a healthy weight (body mass index 18.5-24.9 kg/m(2)), not smoking, consumingor = 1 alcoholic beverage per day, consuming at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization.People with SPD were more likely than those without SPD to report chronic health conditions and less likely to be nonsmokers. No differences were found for the remaining healthy behaviors, healthy body weight, and use of preventive services.Older adults with SPD have a similar pattern of engagement in health behaviors, healthy weight, and use of preventive services compared to those without SPD despite reporting worse health status and presence of multiple chronic health conditions.

Objectives To examine the prevalence and sociodemographic predictors of current depressive symptoms among adults aged 65 years and older. Design and Setting Participants were obtained from the 2006 Behavioral Risk Factor Surveillance System, a population-based list-assisted random-digit-dialed telephone survey of the noninstitutionalized U.S. adults. Participants A total of 45,534 participants aged 65 years and older were interviewed. Measurements Participants completed the Patient Health Questionnaire 8. Those with a Patient Health Questionnaire 8 score ≥10 were considered to have current depressive symptoms. Results Our findings indicated that 95.1% of people ≥65 years old did not report current depressive symptoms and 4.9% reported current depressive symptoms. Younger adults (65–74 years), those with a high school education or less, those with an income of less than $50,000, those with good to fair self-rated health, and those with a disability were more likely to have current depressive symptoms. When stratified by age (65–74, ≥75), there was no difference in the prevalence of current depressive symptoms between the age groups. However, when the authors stratified by age group both adults 65–74 years olds and those ≥75 years old, only people with worse self-rated health and those who reported a disability were more likely to have indicated current depressive symptoms. Conclusion The continued collection of data on current depressive symptoms from a population-based sample of older adults can be used by policymakers and public health officials to identify local health needs and burdens that can assist in planning, directing, implementing, and monitoring the effectiveness of strategies.

Our objective was to examine differences in health-related quality of life (HRQOL) between people with coronary heart disease (CHD) and those without this condition in a population-based sample of U.S. adults and to examine the interaction between CHD and diabetes on HRQOL.We performed a cross-sectional analysis of data from 50,573 participants agedor=18 years from 10 states of the 2004 Behavioral Risk Factor Surveillance System (BRFSS). Data were self-reported. HRQOL was assessed with the Centers for Disease Control and Prevention (CDC) HRQOL-4 measures. After adjusting for age, gender, race or ethnicity, educational status, marital status, employment status, smoking status, body mass index (BMI), and alcohol use, the percentages of women without CHD who, during the previous 30 days, reported experiencingor=14 physically unhealthy days,or=14 mentally unhealthy days, andor=14 activity-limitation days were 7.5%, 10.4%, and 3.6%, respectively, compared with 16.5% (odds ratio [OR] = 2.49, 95% confidence interval [CI] 2.02, 3.07), 14.5% (OR = 1.58, 95%, CI 1.22, 2.04), and 8.4% (OR = 2.56, 95% CI 1.98, 3.30) for women with CHD. The adjusted percentages of men without CHD who reported experiencingor=14 physically unhealthy days,or=14 mentally unhealthy days, andor=14 activity-limitation days were 5.6%, 6.0%, and 3.0%, respectively, compared with 10.1% (OR = 1.85, 95% CI 1.47, 2.32), 8.7% (OR = 1.32, 95% CI 1.00, 1.74), and 6.4% (OR = 1.99, 95% CI 1.49, 2.66) for men with CHD. A higher adjusted percentage of women with CHD reported experiencingor=14 physically unhealthy days (p0.001) andor=14 mentally unhealthy days (p = 0.002) but notor=14 activity-limitation days (p = 0.090) than men with CHD.People with CHD have significantly impaired HRQOL compared with those without CHD. HRQOL among women with CHD is worse than that among men with CHD.

Objective To examine the associations between frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days), health behaviors, body weight, and use of preventive services among adults ≥65 years using the 2003 Behavioral Risk Factor Surveillance System (BRFSS). Methods Participants (N = 52,600) were asked how many days during the past 30 days that their mental health was not good. Having a healthy weight (body mass index 18.5–24.9 kg/m 2 ), not smoking, consuming ≤1 alcoholic beverage per day, consuming of at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization were examined in addition to combinations of these behaviors. Results People with FMD were less likely than those without FMD to be nonsmokers (adjusted odds ratio [AOR] = 0.67, confidence interval [CI] = 0.53–0.85), to consume at least five fruits or vegetables daily (AOR = 0.80, CI=0.70–0.91), and to participate in moderate-to-vigorous physical activity during the average week (AOR = 0.82, CI=0.68–0.99). However, there was no difference between those with and without FMD in the consumption of ≤1 alcoholic beverage per day, having a healthy weight, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization. Conclusions Older adults with FMD are less likely to engage in many health behaviors and to use preventive services than those without FMD.

FORD, EARL S., CHAOYANG LI, LISA C. MCGUIRE, ALI H. MOKDAD, AND SIMIN LIU. Intake of dietary magnesium and the prevalence of the metabolic syndrome among U.S. adults. Obesity. 2007;15:1139–1146. Objective: Limited data suggest that people with the metabolic syndrome have lower intakes or circulating concentrations of magnesium than those who do not have the syndrome. The aim of this study was to examine the associations between dietary intake of magnesium and the prevalence of the metabolic syndrome in a nationally representative sample of U.S. adults. Research Methods and Procedures: We used data for 7669 participants 20 years of age of the Third National Health and Nutrition Examination Survey (1988 to 1994). The metabolic syndrome was defined using the criteria of the National Cholesterol Education Program. Magnesium intake was determined from a single dietary 24-hour recall. Results: The unadjusted prevalences of the metabolic syndrome were 29.0% (quintile of lowest magnesium intake), 27.5%, 25.8%, 23.9%, and 21.8% for increasing quintiles of magnesium intake (p for trend 0.002). After multiple adjustment, the odds ratios for the second through the fifth quintiles (highest intake) of magnesium intake among all participants included in the analysis were 0.84 [95% confidence interval (CI): 0.58, 1.23], 0.76 (95% CI: 0.54, 1.07), 0.62 (95% CI: 0.40, 0.98), and 0.56 (95% CI: 0.34, 0.92), respectively (p for trend 0.029). The associations were similar for men and women. Discussion: Our results showing an inverse association between dietary magnesium intake and the prevalence of the metabolic syndrome add to the evidence that adequate magnesium intake or a diet rich in magnesium may be important for maintaining good cardiometabolic health.

Sex differences in the association between moderate alcohol consumption and cognitive functioning were examined during 4 years.Participants were 2716 US older adults 70 years and older (mean age, = 76.02 years) who were free of cognitive impairment from the Second Longitudinal Study of Aging (1994 to 2000). Multiple logistic regression models were used to predict cognitive functioning (adapted Telephone Interview for Cognitive Status) from average daily alcohol intake (no drink, one drink or less daily, and more than one drink daily) during 4 years after controlling for covariates.Sex differences in the association between alcohol consumption and cognitive functioning were found (p0.01). Older adults with alcohol consumption of one drink or less per day had a lower odds of low cognitive functioning compared with abstainers for women (adjusted odds ratio [AOR], 0.67; 95% confidence interval [CI], 0.55-0.83), but not men (AOR, 0.96; 95% CI, 0.69-1.34).For older adults with a level of cognitive functioning within normal ranges, moderate amounts of alcohol, an average of one drink or less daily, was protective for women, but not men. Caution should be used in suggesting moderate alcohol consumption to maintain cognitive functioning because of the risks of consuming alcohol.

Objective: Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF. Design: Population-based, cross-sectional surveys. Setting: Third National Health and Nutrition Examination Survey (NHANES III). Participants: Data from 5549 men and non-pregnant women aged ⩾40 years in NHANES III were analysed. Results: About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA. Conclusions: MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.

Background Reducing added sugars intake is one of the Healthy People 2020 objectives. High added sugars intake may be associated with adverse health consequences. Objective This cross-sectional study identified sociodemographic and behavioral characteristics associated with added sugars intake among US adults (18 years and older) using the 2010 National Health Interview Survey data (n=24,967). Methods The outcome variable was added sugars intake from foods and beverages using scoring algorithms to convert dietary screener frequency responses on nine items to estimates of individual dietary intake of added sugars in teaspoons per day. Added sugars intake was categorized into tertiles (lowest, middle, highest) stratified by sex. The explanatory variables were sociodemographic and behavioral characteristics. Multinomial logistic regression was used to estimate the adjusted odds ratios for the highest and middle tertile added sugars intake groups as compared with the lowest tertile group. Results Estimated median added sugars intake was 17.6 tsp/d for men and 11.7 tsp/d for women. For men and women, those who had significantly greater odds for being in the highest tertile of added sugars intake (men: ≥22.0 tsp/d; women: ≥14.6 tsp/d) were younger, less educated, had lower income, were less physically active, were current smokers, and were former or current infrequent/light drinkers, whereas non-Hispanic other/multiracial and those living in the West had significantly lower odds for being in the highest tertile of added sugars intake. Different patterns were found by sex. Non-Hispanic black men had lower odds for being in the highest tertile of added sugars intake, whereas non-Hispanic black women had greater odds for being in the highest tertile. Conclusions One in three men consumed ≥22.0 tsp added sugars and one in three women consumed ≥14.6 tsp added sugars daily. Higher added sugars intake was associated with various sociodemographic and behavioral characteristics; this information can inform efforts to design programs and policies specific to high-intake populations.

Introduction Racial/ethnic differences in recent obesity trends have not been reported among young low-income children. The purpose of this study is to examine trends in obesity prevalence from 1998 through 2011 by race/ethnicity among low-income children aged 2–4 years. Methods The study was based on measured weight and height records of 29,040,851 participants of federally funded health and nutrition programs from 30 states and the District of Columbia, which provided data each year from 1998 through 2011. More than 80% of data were collected through the Special Supplemental Nutrition Program for Women, Infants, and Children, and about 50% of eligible children were included. In 2014, joinpoint regression was used to identify the inflection years when significant changes in obesity trends occurred and piecewise logistic regression was used to examine annual changes in obesity prevalence before and after the inflection years controlling for age, sex, and race/ethnicity. Results The overall obesity prevalence increased from 13.05% in 1998 to 15.21% in 2003, and decreased slightly to 14.74% in 2011. The increasing trends among non-Hispanic white, non-Hispanic black, and Hispanic children began decreasing in 2003. Asian/Pacific Islander was the only racial/ethnic group with a continual decreasing trend in obesity prevalence from 1998 (14.34%) through 2011 (11.66%). Among American Indian/Alaska Native children, obesity prevalence consistently increased from 16.32% in 1998 to 21.11% in 2011, although the annual increases slowed since 2001. Conclusions The study findings indicate modest recent declines in obesity prevalence for most racial/ethnic groups of low-income children aged 2–4 years. However, obesity prevalence remains high.

Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States.To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries.Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed.NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs.Cases of TBI were identified from approximately 500,000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP.Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced.Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps.001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8% (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps.001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs.The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Prevention's Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex.

BACKGROUND. Headaches are common among children and adolescents, particularly migraine and tension-type headaches. They contribute to missed school days, affect children's peer and family relationships, and significantly impact children's quality of life, often times into adulthood. OBJECTIVES. This study, based on responses to the Strengths and Difficulties Questionnaire, was designed to examine difficulties and impairments related to emotions, concentration, behavior, and social functioning among children with frequent or severe headaches (FSH). METHODS. We used a cross-sectional study of 9264 children aged 4–17 years from the 2003 National Health Interview Survey, an ongoing, computer-assisted personal interview survey of the noninstitutionalized US population. RESULTS. Approximately 6.7% of children experienced FSH during the previous 12 months. Overall, children with FSH were 3.2 times more likely than children without FSH to have a high level of difficulties and 2.7 times more likely to have a high level of impairment, suggesting potential mental health issues. More specifically, analyses revealed that children with FSH were significantly more likely than those without FSH to exhibit high levels of emotional, conduct, inattention-hyperactivity, and peer problems and were significantly more likely than children without FSH to be upset or distressed by their difficulties and to have their difficulties interfere with home life, friendships, classroom learning, and leisure activities. CONCLUSION. Because children with FSH experience notable pain, mental health issues, and functional limitations, integrated care using a biopsychosocial approach is warranted.

One priority action in “The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013–2018” is surveillance of cognitive health issues. CDC’s Healthy Aging Program (HAP) has developed and promulgated the use of two modules, on subjective cognitive decline and caregiving, in the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is the world’s largest ongoing telephone health-related survey, collecting data in 50 states and three U.S. territories. The HAP enlisted the help of subject matter experts and used cognitive testing to refine and improve these modules.

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

Remembering medical information over time is important for patients' health and well-being. Younger and older adults' respective memories of information from a videotaped medical feedback session about osteoarthritis were examined as a function of information organization. Participants were randomly assigned to either an organized or an unorganized presentation condition. Retention was assessed immediately, and after 1-week and 1-month delays, by use of a free-recall task. Younger and older adults in general remembered equivalent amounts of medical information. Organization of medical information did not have an impact on the amount of information remembered. Results indicated that participants recalled more medical information immediately than after the 1-week and 1-month delays. Younger adults initially recalled more medical information than older adults; however, younger and older adults remembered equivalent amounts of information after the 1-week and 1-month delays.

To examine the associations among health behaviors, healthy body weight, and use of preventive services of adults 65 years and older using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) as a function of caregiving status.Participants (N=6,138) residing in the states of Hawaii, Kansas, and Washington completed questions about caregiving. We examined if there were any associations among body weight--having a healthy weight (body mass index 18.5-24.9 kg/m2); modifiable health behaviors--not smoking, consumingor = 1 alcoholic beverage per day, consuming at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week; and using preventive services--receiving an annual influenza immunization, and ever receiving a pneumococcal immunization.The two groups did not differ significantly on the modifiable health behaviors of fruit and vegetable consumption, smoking status, or alcohol consumption, or having a healthy weight. Caregivers were significantly more likely to meet physical activity recommendations than non-caregivers (54.1%, 42.0%, respectively, p0.001). No significant differences were found between caregivers and non-caregivers on receiving influenza and pneumococcal immunization.Older adults who are caregivers are more likely than other older adults to meet government recommendations for physical activity; however, they have similar patterns of engaging in other health behaviors, including health eating and use of preventive services.

In this article, we outline 2 projects that highlight the multidimensionality of aging processes for adult development and aging courses. These projects tie together biological, psychological, and sociocultural aspects of aging by creatively integrating and applying course materials to real-world situations. In the first project, students design an age-appropriate retirement community using buildings on the local college campus. In the other, students present products they design to remedy specific age-related problems.