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Asian Americans (AAs) are the fastest-growing racial/ethnic minority group in the United States. While otherwise highly heterogeneous, AAs overall value filial piety and eldercare. This study compared the health and caregiving experiences of AA caregivers of older adults to AA non-caregivers and caregivers of older adults across racial/ethnic groups. We used 2015–2020 Behavioral Risk Factor Surveillance System data for 315 AA caregivers and 3822 AA non-caregivers, plus 395 American Indian/Alaska Native, 1883 Black, 1292 Hispanic, and 20,321 non-Hispanic White caregivers. Among AAs, 4.3% were caregivers, a lower proportion than in other racial/ethnic groups. Most AA caregivers were female (59%), married (71%), in excellent/very good/good health (76%), and with at least one chronic health condition (66%). Other than relationship to care recipients, caregivers’ experiences were similar across racial/ethnic groups: most cared for

Caregiving provides numerous benefits to both caregivers and care recipients; however, it can also negatively affect caregivers' mental and physical health (1-4), and caregiving tasks often require physical exertion (1). Approximately 44% of adults with arthritis report limitations attributable to arthritis, including trouble doing daily activities (5). These limitations might affect caregivers' ability to provide care, but little is known about arthritis among caregivers. To assess arthritis among caregivers of a family member or friend, CDC examined data from 17 states that administered both the arthritis and caregiving modules as part of the Behavioral Risk Factor Surveillance System (BRFSS) in either 2017 or 2019. Approximately one in five adults (20.6%) was a caregiver. Prevalence of arthritis was higher among caregivers (35.1%) than noncaregivers (24.5%). Compared with caregivers without arthritis, those with arthritis provided similar types of care and were more likely to have provided care for ≥5 years and for ≥40 hours per week. In addition, higher proportions of caregivers with arthritis reported disabilities compared with those without arthritis, including mobility issues (38.0% versus 7.3%). Arthritis among caregivers might affect their own health as well as the care they can provide. Caregivers can discuss their arthritis and related limitations with a health care professional to identify ways to increase their physical activity and participation in lifestyle management programs.* Such interventions might ease arthritis pain and related limitations and might support them in their ongoing caregiving role. Public health professionals can implement strategies to support caregivers throughout the caregiving process.

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).

One in four Baby Boomers fills the informal caregiver role in the United States. The objectives of this study were to estimate the prevalence of Baby Boomers who are informal caregivers for people living with dementia and compare their physical and mental health status to caregivers for persons with conditions other than dementia using 2015–2018 Behavioral Risk Factor Surveillance System data (N = 10,602). We identified caregiving status (assisting a family member/friend with a long-term illness or disability in the past month, managing personal care, and not caring for a child/grandchild) and whether the care recipient’s major health condition was dementia. We calculated weighted estimates and used chi-square tests and log-binomial regression for comparisons of selected characteristics. Among Baby Boomer caregivers, 15.4% were caring for someone with dementia. Dementia caregivers were more likely to be female, caring for a parent/parent-in-law, and providing care longer than caregivers for persons without dementia. After adjusting for sociodemographic and caregiving characteristics, the prevalence of fair/poor health, frequent mental distress, and chronic conditions were similar across types of caregivers. Although no differences in caregiver’s physical and mental health by care recipient’s dementia status were found, we should underscore the importance of maintaining Baby Boomer caregivers’ health and well-being.

Caregivers provide a critical source of care for people living with disabilities and chronic conditions. They improve health outcomes among care recipients while risking negative health consequences themselves. Nevertheless, the need for more caregivers is substantial. Therefore, caregiving is a public health concern. Public health seeks to improve the health of populations in an equitable way. This chapter illustrates a public health approach to supporting caregivers of people with dementia using the Healthy Brain Initiative: State and Local Public Health Partnerships to Address Dementia, the 2018–2023 Road Map. It is framed using essential public health services and identifies 25 strategies for public health action to support caregivers. The Road Map could serve as a template for supporting caregivers more broadly. Addressing the anticipated family care gap requires that public health systems collaborate to collect data and equitably implement evidence-based policies and programs that support people providing care in their communities.

Subjective cognitive decline (SCD) is receiving increasing attention as studies have suggested that SCD status is associated with risk of future cognitive decline and dementia. Population‐based measures of SCD can be extremely useful to the public health community, health‐care providers, researchers, and policymakers. A large population‐based SCD measure now exists through the state‐based Behavioral Risk Factor Surveillance System (BRFSS). All 50 states have included the cognitive decline module, which asks about SCD, to their BRFSS survey one or more times. Population measures of SCD can aid researchers in designing clinical studies by better estimating the populations that may be at risk for more severe cognitive decline based on their SCD status to ensure that the optimal groups are targeted. Population‐level estimates of SCD can also help to inform health‐care providers’ decisions about initiating cognitive assessments, managing other conditions among those with memory problems, and identifying the needs of caregivers.

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.

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 $13 069 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.

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.

The present study used the CDC’s 2017 Behavioral Risk Factor Surveillance System and Structural Equation Modeling (SEM) to test the Meikirch model’s theoretical definition of health and aging. This biopsychosocial and ecological framework considers the dynamic interplay between an individual’s biology, health behavior and health potential, social surroundings, physical environment, and demands of living on both mental and physical health outcomes. A total sample of 96,568 adults were included with a mean age of 66.05 years (SD = 9.91). Individuals were classified in the following age groups: 43% middle-aged (45-64 years), 33% young-old (65-74 years), and 25% old-old adults (75+ years). The sample was largely female (61%), Non-Hispanic White (86%), and urban (67%). A CFA and WLSMV estimation was used to assess each latent construct. The overall SEM model was found to be a good fit (RMSEA=0.05, CFI=0.94, TLI=0.90), explained a significant portion of the variance in the health outcome (65%), and appeared to mimic prior literature on health variable relationships. An important finding within this study suggests the significant relationship between education, personally acquired potential, and health outcome variables. Underscoring health education and health literacy interventions may positively promote a person’s health behavior, resource access, and health outcomes across the lifespan. The Meikirch model can be used as a framework in public health interventions to better understand health adaptation, as well as behavioral risks and systematic hurdles. Overall, the study emphasizes how understanding health is not exclusively an individual hurdle to tackle, but a communal goal.

Alzheimer’s disease and related dementias often begin with symptoms of mild memory loss, eventually leading to more severe cognitive impairment, functional impairment, and ultimately, death. Data from the Behavioral Risk Factor Surveillance System core questions related to chronic diseases and from the cognitive decline optional module on subjective cognitive decline (SCD) from the years 2015-2018 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among U.S. adults aged 65 years and older, only 39.8% (95%CI=37.6-42.1) of those experiencing SCD reported discussing their SCD symptoms with a healthcare provider. The prevalence of discussing SCD symptoms with a provider was higher among those with at least one chronic condition than among those with no chronic conditions. 30.7% (28.6-32.8) of those aged 65 years and older reported that their SCD led to functional limitations and 28.8% (26.5-31.2) needed assistance with day-to-day activities. For patients aged 65 years and older, Welcome to Medicare visits and Medicare Annual Wellness Visits are critically underutilized primary care access points. Primary care providers can manage chronic conditions, cognitive health, and initiate referrals for testing. Efforts to promote the use of toolkits and diagnostic codes that are available to primary care providers to initiate conversations about memory loss with patients may be utilized to improve detection, diagnosis, and planning for memory problems. Discussions may lead to earlier detection and diagnosis of cognitive impairment, such as Alzheimer’s disease, or other treatable conditions such as delirium or pressure in the brain and avoid costly hospitalizations.

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).

Objective-This report describes cognitive performance in the U.S. noninstitutionalized population of older adults. The association of sociodemographic factors and self-reported cognitive and health status with low cognitive performance is also investigated. Methods-During 2011-2014, the cognitive performance of participants aged 60 and over was assessed during the National Health and Nutrition Examination Survey (NHANES). Cognitive assessment was based on scores from established objective cognitive tests (word list learning with immediate and delayed recall, animal naming, and a digit symbol substitution test). Mean scores and percentile distributions were described by sociodemographic characteristics. Logistic regression modeling was conducted to evaluate the relationship of sociodemographic and self-reported health factors with low cognitive performance, defined by scores in the lowest 25th percentile. The relationship between objective cognitive functioning measures and subjective cognitive decline also was evaluated by calculating sensitivity and specificity measures. Results-A total of 3,181 adults completed at least one of four objective cognitive tests. Mean scores for men were lower than for women in three of four assessments. Mean scores decreased with increasing age and with decreasing level of income and education. Persons reporting poorer health status and subjective cognitive decline were more likely to have low performance on the four assessments. The subjective cognitive decline question had low sensitivity (22.9%-26.7%) in identifying low cognitive performers, but had high specificity in identifying those who did not score low on the cognitive assessments (89.3%-90.9%). Conclusions-Cognitive performance has important implications for the U.S. aging population. Subjective cognitive decline along with older age, low income, low educational attainment, and fair or poor self-reported health were independently associated with lower cognitive performance in a representative sample of U.S. older adults.

As the proportion of older adults in the United States is projected to increase dramatically in the coming decades, it is imperative that public health address and maintain the cognitive health of this growing population. More than 5 million Americans live with Alzheimer’s disease and related dementias (ADRD) today, and this number is projected to more than double by 2050. The public health community must be proactive in outlining the response to this growing crisis. Promoting cognitive decline risk reduction, early detection and diagnosis, and increasing the use and availability of timely data are critical components of this response. To prepare state, local, and tribal organizations, CDC and the Alzheimer’s Association have developed a series of Road Maps that chart the public health response to dementia. Since the initial Healthy Brain Initiative (HBI) Road Map release in 2007, the Road Map has undergone two new iterations, with the most recent version, The HBI’s State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map, released in late 2018. Over the past several years, significant advances were made in the science of risk reduction and early detection of ADRD. As a result, the public health response requires a life-course approach that focuses on reducing risk and identifying memory issues earlier to improve health outcomes. The most recent Road Map was revised to accommodate these strides in the science and to effect change at the policy, systems, and environment levels. The 2018–2023 Road Map identifies 25 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. The actions are categorized into four traditional domains of public health, and the Road Map can help public health and its partners chart a course for a dementia-prepared future.

Purpose: Characteristics of parents who purchased kids’ meals, reasons for the purchase, and desire for healthy options were examined. Design: Quantitative, cross-sectional study. Setting: National. Participants: The SummerStyles survey data of 1147 parents (≥18 years). Measures: Self-reported outcome variables were purchase of kids’ meals (yes/no), reasons for the purchase (13 choices), and desire for healthy options (yes/no). Analysis: We used multivariable logistic regression to estimate odds ratios (ORs) for purchasing kids’ meals based on parental sociodemographic and behavioral characteristics. Results: Over half (51%) of parents reported purchasing kids’ meals in the past month. The adjusted OR of purchasing kids’ meals were significantly higher among younger parents (OR = 3.44 vs ≥50 years) and among parents who consumed sugar-sweetened beverages (SSBs) daily (OR = 2.70 vs none). No differences were found for race/ethnicity, income, and education. Parents who purchased kids’ meals reported that the top 3 reasons for purchase were (1) because their children asked for kids’ meals, (2) habit, and (3) offering of healthier sides such as fruits or fruit cups. Thirty-seven percent of parents who did not purchase kids’ meals expressed willingness to purchase kids’ meals if healthy options were available; this willingness was highest among younger parents (47%; P < .05). Conclusions: Kids’ meal purchases were somewhat common. Our findings on characteristics of parents who frequently bought kids’ meals (ie, younger parents and SSB consumers), common reasons for purchasing kids’ meals, and willingness to buy healthier kids’ meal can be used to inform intervention efforts to improve quality of kids’ meals.

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.

Home- and community-based services (HCBS) can reduce caregiver burden. We compared the prevalence of HCBS unmet needs among caregivers in rural and urban areas and identified factors associated with unmet HCBS needs. We used 2015-2018 Behavioral Risk Factor Surveillance System data, including the optional Caregiver Module, from 44 states, District of Columbia, and Puerto Rico. Caregivers were individuals providing care/assistance to a friend/family member with a long-term illness/disability during the past 30 days. Unmet needs were defined as needing, but not receiving, one or more of the following: caregiving classes, help accessing services, support groups, individual counseling, or respite care. “Rural” was defined as living outside Metropolitan Statistical Areas (available only for landline respondents). We calculated weighted estimates and used log-binomial regression to estimate adjusted prevalence ratios (PR). 19% of 25,180 caregivers lived in a rural area. Rural caregivers were less likely to report unmet HCBS needs (14.4% versus 20.6% urban, p

The Healthy Brain Initiative (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 (RMIC), 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. This session will describe how the initiative evolved over the past 15 years including policy and implementation success stories.

Millennials (born 1981-1996), now outnumber Baby Boomers. Millennials have the unique task of potentially providing care for their own children, their aging parents, and grandparents, making them the first “club sandwich” generation. We utilized data from 44 states, the District of Columbia, and Puerto Rico from the 2015-2018 Behavioral Risk Factor Surveillance System to estimate the prevalence of informal caregiving among Millennials (based on age at the time of survey completion: 18-34 in 2015, 19-35 in 2016, 20-36 in 2017, and 21-37 in 2018). We conducted log-binomial regression analyses to compare mental and physical health among Millennials, adjusting for age, sex, education, and race/ethnicity. Among 37,780 Millennials included, 18.7% provided regular care/assistance to a friend/family member with a health problem, long-term illness, or disability in the past month. Of these caregivers, 36.3% provided the most care to a parent/parent-in-law and 21.8% to a grandparent. Half of Millennials had ≥1 children under age 18 in their home, regardless of caregiving status. In adjusted models, Millennial caregivers had higher prevalence of frequent mental distress [≥14 days in the past 30 days when mental health was not good] (prevalence ratio [PR]=1.72, 95% confidence interval [CI]: 1.50-2.00, p

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.

The Healthy Brain Initiative (HBI) has reached an inflection point. Since 2005, HBI partners -- Centers for Disease Control and Prevention (CDC), Alzheimer’s Association, and others -- have stimulated increased acceptance among state public health departments that Alzheimer’s and other dementias are a growing public health challenge. Now many public health leaders are ready to initiate low-cost population-based approaches to dementia and caregiving. Other significant HBI gains have occurred in public health surveillance, workforce development, early detection and diagnosis, risk reduction, and caregiver support. Nearly every state has fielded Behavioral Risk Factor Surveillance System (BRFSS) modules on subjective cognitive decline and caregiving. Schools of public health are teaching undergraduate students with a new curriculum on Alzheimer’s as a public health issue. State public health agencies are educating the public and clinicians about cognitive assessments, promoting health behaviors associated with cognitive functioning, and testing interdisciplinary models to help support dementia caregivers.

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.

Older Americans are at increased risk for chronic conditions. Of adults 65 years and older, 80% live with at least two chronic conditions. Managing chronic conditions can be burdensome and require decision-making abilities to manage treatment protocols. Cognitive decline, with associated memory loss and confusion, might impair a person’s ability to manage chronic health conditions. This study examined chronic conditions in persons with subjective cognitive decline (SCD) defined as the self-reported experience of increased memory problems or confusion over the past year. Data from the 2015 and 2016 Behavioral Risk Factor Surveillance System telephone survey 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 65 years and older from 49 states, District of Columbia, and Puerto Rico that collected data on cognitive decline. Persons with SCD had a significantly higher unadjusted prevalence compared to those without for each chronic disease examined including the most prevalent ones: arthritis (64% vs. 50%), depression (34% vs. 12%), diabetes (30% vs. 22%) and heart disease 28% vs. 17%), all p

Many middle-age and older Americans who identify as lesbian, gay, or bisexual (LGB) are part of a generation where sexual orientation was treated as a disorder. Consequently, many older LGB Americans experienced discrimination or acted to conceal their sexual orientation, actions that might have put them at risk for social isolation and loneliness—factors both associated with developing or hastening cognitive decline, including dementia. This study examined differences in subjective cognitive decline (SCD), defined as the self-report of increased memory problems or confusion over the past year, between LGB and heterosexual men and women. Data from the 2015 and 2016 Behavioral Risk Factor Surveillance System were used to define SCD in self-identified 110,394 individuals 45 years and older from 23 states of which 2,466 identified as LGB. Compared to heterosexual women, lesbian and bisexual women (as a group), had higher age-adjusted odds for SCD (odds ratio [OR]=1.57, p=0.011). Lesbian and bisexual women also had higher odds for having functional limitations due to SCD, including an impeded ability to work, volunteer, or socialize outside the home or having to give up day-to-day activities like cooking or driving (OR=1.22, p=0.011). Compared to heterosexual men, gay and bisexual men (as a group), did not have statistically different odds for SCD (OR=1.37, p=0.052) or functional limitations due to SCD (OR=1.01, p=0.96). LGB identity was associated with SCD among women but not among men. Previous research has found higher prevalence of cardiovascular risk factors like obesity among lesbian women, which could partially explain this finding.

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.