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A study examined 127 parents' understanding of attention deficit/hyperactivity disorder (ADHD), and differences by ethnicity, child gender, treatment status, and sociodemographic status. White parents were more likely than African-American parents to apply medical labels, expect a lifelong course, seek school interventions, and address academic and social outcomes. (Author/CR)

In the United States, diabetes is the seventh leading cause of death and continues to rise in prevalence, with type 2 diabetes accounting for 90–95% of all cases. Rates of diabetes in Kentucky, and, in particular, the Appalachian region, are among the highest in the nation and are increasing faster than the national average. Despite this disproportionate burden, barriers to clinical appointment attendance have not been fully explored in this population. This article examines the association among perceived barriers to clinical attendance, glycemic control, and diabetes self-care as part of an ongoing study. We used a 25-item checklist developed using the Chronic Care Model to assess participants' barriers to clinic attendance. Glycemic control was assessed via A1C measurement. Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities measure. At the time of analysis, 123 of the 356 participants (34.6%) did not report any barriers to clinic attendance. For the remainder, the major reported barriers included forgetting appointments, inability to afford medicines or other treatment, and placing faith above medical care. The average A1C was 7.7%, and the average diabetes self-care summary score was 17.1 out of 35 points (with higher values indicating better self-care). Missing clinic appointments is associated with lower health outcomes, especially in vulnerable populations. This study can help educate clinic staff on perceived barriers to type 2 diabetes management among people with diabetes in Appalachia. [ABSTRACT FROM AUTHOR]

To combat maternal morbidity and mortality, interventions designed to increase physical activity levels during and after pregnancy are needed. Mobile phone-based interventions show considerable promise, and BumptUp® has been carefully developed to address the lack of exercise among pregnant and postpartum women. The primary goal of this pilot study was to test the potential efficacy of BumptUp® for improving physical activity among pregnant and postpartum women. A randomized controlled clinical trial was performed (N = 35) with women either receiving access to the mhealth app or an educational brochure. Physical activity and self-efficacy for exercise data were collected at baseline (in mid-pregnancy) and at three additional timepoints (late pregnancy, 6 and 12 weeks postpartum). For moderate-to-vigorous physical activity, a clear trend is observed as the mean estimated difference between groups increases from −0.35 (SE: 1.75) in mid-pregnancy to −0.81 (SE: 1.75) in late pregnancy. For self-efficacy for exercise, the estimated difference of means (control–intervention) changed from 0.96 (SE: 6.53) at baseline to −7.64 (SE: 6.66) in late pregnancy and remained at −6.41 (SE: 6.79) and −6.70 (SE: 6.96) at 6 and 12 weeks postpartum, respectively. When assessing the change in self-efficacy from mid-to -ate pregnancy only, there was a statistically significant difference between groups (p = 0.044). BumptUp® (version 1.0 (3)) shows potential for efficacy. Pilot data suggest key refinements to be made and a larger clinical trial is warranted. [ABSTRACT FROM AUTHOR]

Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appala chian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and mainraining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker: inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests. KEYWORDS. Appalachia, rural women, attitudes/perceptions, cervical cancer, screening

In Western nations, cardiovascular disease (CVD) is the leading cause of death and disability, and myocardial infarction (MI or heart attack) is responsible for the most significant proportion of these deaths. Over the past decades, however, mortality rates from CVD in general and MI specifically have been decreasing due in large part to the proliferation of time-dependent therapies. As their description suggests, the use of such effective therapies is associated with early hospital presentation, thus reducing treatment time has significant benefits. Previous research most often has focused on sociodemographic or clinical factors influential in treatment timing, while the activities that individuals undertake during the critical hours prior to presentation for formal medical treatment remain insufficiently examined. Since self-care activities provide a window into how cardiac symptom sufferers conceptualize and act on their distress and, subsequently, how these conceptualizations shape treatment timing, we sought a more complete understanding of the relationship between self-care behaviours and treatment timing. Employing a complementary design, we examined data from 2972 survivors participating in the MI Onset study in the United States and 35 survivors from the MI Illness Narrative Study. Results indicate that cardiac self-care played a defining role in time to treatment, while other factors (i.e., sociodemographic and clinical factors) did not. Specifically, taking over-the-counter medications (i.e., analgesics and antacids) was associated with a longer treatment time. A closer look at who was likely to pursue these strategies and their reasons behind so doing leads us to conclude that (1) social location and self-identity; (2) previous health experiences, including personal health history and prior use of self-care strategies and; (3) social interaction play important roles in cardiac self-care responses which, in turn, shape treatment timing. Keywords: Myocardial infarction; Self-care; Time to treatment; USA

Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of 'standard' cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices. Keywords: Coronary heart disease; Women; Gender; Ethnicity; Symptomatology; Lay perceptions of illness; USA

The maintenance of good nutritional status is a cornerstone of health, function, and quality of life. To assess indicators and correlates of high levels of nutritional risk, sociodemographic, functional status, and nutritional data were collected from a diverse sample of 729 older women. Results from ordered logit analysis indicated that being Black, having an income [less than or equal to]125% of the federal poverty level, living alone, and being in the younger-old age group (ages 60 to 74 years) were associated with moderately high and very high levels of nutritional risk. An examination of individual and multiple nutritional risk indicators suggested a heightened vulnerability of Black women to inadequate dietary intake, even net of income and other influential variables. With demographic projections of an increasingly numerous and diverse older population who may face health and nutritional challenges, researchers must strengthen efforts to assist policymakers and service providers to properly target nutrition services KEYWORDS. Nutritional risk, women, blacks, elderly, home-delivered meals, frail

We currently lack critical information about an important component of community-based service use-attitudes about these services. To understand such attitudes, 115 older adults (age 65+) participated in in-depth interviews. Because of their vulnerability to poor health status, insufficient resources, and low use of formal services relative to their needs, we oversampled African-American and rural elders. Both positive and negative attitudes were expressed about formal services, with five overarching categories of concern emerging from the analyses. These concerns included (1) the quality of the program or staff; (2) security; (3) cost and eligibility requirements; (4) transportation; and (5) logistical elements. Implications and recommendations are suggested. KEYWORDS. Community-based services, rural, African-American, attitudes, vulnerable populations

Issues related to the role physicians and clergy may play in influencing the elderly to take advantage of social services are examined. Topics include senior citizens' belief that physicians and clergy play an important role in social service for the elderly and ways in which physicians and clergy may exert their influence.

Attention deficit hyperactivity disorder (ADHD) is considered the most common child psychiatric disorder in the United States of America. Despite the high prevalence (estimated at 3-5%), little is known about the level and source of knowledge about ADHD among those affected by the disease, and about cultural and ethnic variations in knowledge levels and information sources. This represents a serious deficit, because health behavior, including demand for health services, is thought to be strongly influenced by knowledge or beliefs held by individuals and their networks. Furthermore, recent research suggested minority children may be less likely to receive services for ADHD. To examine possible differences in ADHD knowledge and information source, a sample of 486 African-American and white parents of children at high risk for ADHD were surveyed by telephone and subsequently participated in face-to-face interviews addressing their explanatory models of ADHD. Results revealed significant ethnic differences in knowledge and sources of information about ADHD. Fewer African-American parents than white parents indicated that they had ever heard of ADHD (69% compared to 95%, P < 0.001), or that they knew some or a lot about it (36% compared to 70%, P < 0.001) African-American parents were more likely to attribute ADHD to excessive sugar in the diet than whites (59% compared to 30.0%, P < 0.001). Finally, even though the physician was listed as the most preferred information source for both groups, only 17.5% of African-American parents reported they had received information about ADHD from the physician compared to 29% of whites (P < 0.01). African American parents reported less use of and less preference for written informational materials (newspapers, journals, library) than white parents. We conclude that substantially more research should be undertaken to examine the relationship between ethnicity and ADHD knowledge, to inform culturally appropriate education campaigns and to improve access to services for this important treatable child mental health condition. Key words - attention deficit disorder, hyperactivity, knowledge and attitudes, ethnicity

An examination of the attitudes of older African-American rural and urban women was presented by the use of interviews. Results show that attitudes about nursing homes vary by place of residence among older African-American women. Furthermore, most elderly women have positive views on the possibility of entering a nursing home and that this perception is actually influenced by their own families. These findings provide insights on long-term care decision making.

Differences in the physical and social environment lead to differences in the reasons for entering a nursing home between elders from rural and urban communities. Rural elders report an injury related to a fall as a reason for admission to the nursing home less often than urban elders. Physicians are most frequently mentioned by urban elders, and family members by rural elders as suggesting entering a nursing home. Rural elders report the need for skilled care less often as a reason for admission than urban elders. Rural elders describe fear of living in a community more often than urban elders.

Poverty and poor health disproportionately affect older adults serving as primary caregivers to their grandchildren. In underserved, rural regions, where grandparent caregivers may be especially vulnerable, grandparent caregivers may find support in cultural traditions. As part of a mixed methods study investigating stress among grandparent caregivers, the role religion and spirituality play in coping was explored using a survey complemented by semi-structured interviews with 26 rural grandparent caregivers. Findings suggest religion and spirituality facilitate coping by (a) providing a sense of purpose and perspective; (b) fostering peace and perseverance; and (c) promoting stability and social cohesion. This study describes how cultural assets aid grandparent caregivers' coping and may inform supportive policies and practices for grandfamilies. [ABSTRACT FROM AUTHOR]

Background: Most children in the United States receive far less physical activity (PA) than is optimal. In rural, under resourced areas of Appalachian Kentucky, physical inactivity rates are significantly higher than national levels. We sought to understand children's perceptions of PA, with the goal of developing culturally appropriate programming to increase PA. Methods: During 11 focus groups, we explored perspectives on PA among 63 Appalachian children, ages 8-17. Sessions were tape recorded, transcribed, content analyzed, and subjected to verification procedures. Results: Several perspectives on PA emerged among these rural Appalachian youth, including the clear distinction between PA (viewed as positive) and exercise (viewed as negative) and an emphasis on time and resource factors as barriers to adequate PA. Additional PA determinants expressed in the focus groups are similar to those of other populations. We include children's recommendations for appealing PA programs. Conclusions: Appalachian and other rural residents contend with the loss of rural health advantages (due to declines in farming/other occupational and a vocational transitions). At the same time, Appalachian residents have not benefitted from urban PA facilitators (sidewalks, recreational facilities, clubs and organized leisure activities). Addressing low PA levels requires extensive community input and creative programming. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionChronic respiratory disease disproportionately affects residents of Appalachia, particularly those residing in Central Appalachia. Asthma is particularly burdensome to Central Appalachian residents regarding cost and disability. Improving our understanding of how to mitigate these burdens requires understanding the factors influencing asthma control among individuals with asthma living in Central Appalachia, specifically rural Kentucky.This community-based, cross-sectional epidemiologic study used survey data to identify characteristics associated with uncontrolled and controlled asthma. The designation of “uncontrolled asthma” was based on a self-report of ≥ 2 asthma exacerbations in the past year. Individuals with ≤ 1 or no exacerbations were considered to have controlled asthma. Chi-square or Fisher exact tests assessed the association between categorical variables and asthma control categories. Logistic regression was conducted to determine the impact of factors on the likelihood of uncontrolled asthma.In a sample of 211 individuals with self-reported asthma, 29% (n = 61, 46 females) had uncontrolled asthma. Predictors of uncontrolled asthma included depression (odds ratio 2.61, 95% CI 1.22–5.61, p = .014) and living in multi-unit housing (odds ratio 4.99, 95% CI 1.47–16.96, p = .010) when controlling for age, sex, financial status, and occupation. Being overweight or obese was not a predictor of uncontrolled asthma. Physical activity and BMI did not predict the likelihood of uncontrolled asthma.This study highlights significant challenges rural communities in Appalachian Kentucky face in managing asthma. Factors like depression, housing conditions, and a lack of self-management strategies play pivotal roles in asthma control in this population. [ABSTRACT FROM AUTHOR]

African Americans living in a southern, rural community use their folk beliefs about high blood pressure symptoms to guide their daily actions. The refusal of the medical profession to recognize the value of folk medical beliefs such as these is discussed.

Objectives: This study sought to identify older patients’ perceptions of primary care providers’ influence on their likelihood of improving diet and physical activity. Methods: 104 adults ages 65 and older were interviewed immediately following a routine primary care visit about their plans and motivations for behavior change and how their clinic visit would influence their likelihood of making lifestyle changes. All interviews were recorded, transcribed and analyzed using a constant comparison approach. Results: Participants reported that their providers influence their health behaviors by developing strong relationships, addressing concerns and encouraging change, and providing concrete instruction. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, participants often perceived the message that they should continue their current behaviors. Conclusions: Whether and how diet and physical activity are discussed in primary care influences the likelihood that older adults will make changes in these behaviors. Clinical Implications: These findings highlight the need for a patient-centered counseling approach and caution providers to think twice before omitting discussion of the need for lifestyle change. [ABSTRACT FROM AUTHOR]