Background and aim: Providing care to an older adult with a disability has been associated with increased risk to the caregiver's health, but most previous studies of caregiving and health compare persons who are already caregivers with poorly matched non-caregiving controls and are often based on convenience samples. In this report, we describe the enrollment of persons who transitioned into a family caregiving role while participating in a national epidemiological study.Methods: Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were asked on two occasions 9-14 years apart if they were providing care on an ongoing basis to a family member with a chronic illness or disability. Those who answered "no" and "yes," respectively, to this caregiving question and reported sufficient caregiving *

In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.

BACKGROUND/OBJECTIVES Few studies have rigorously examined the magnitude of changes in well‐being after a transition into sustained and substantial caregiving, especially in population‐based studies, compared with matched noncaregiving controls. DESIGN We identified individuals from a national epidemiological investigation who transitioned into caregiving over a 10‐ to 13‐year follow‐up and provided continuous in‐home care for at least 18 months and at least 5 hours per week. Individuals who did not become caregivers were individually matched with caregivers on age, sex, race, education, marital status, self‐rated health, and history of cardiovascular disease at baseline. Both groups were assessed at baseline and follow‐up. SETTING REasons for Geographic And Racial Differences in Stroke study. PARTICIPANTS A total of 251 incident caregivers and 251 matched controls. MEASUREMENTS Perceived Stress Scale (PSS), 10‐Item Center for Epidemiological Studies‐Depression (CES‐D), and 12‐item Short‐Form Health Survey quality‐of‐life mental (MCS) and physical (PCS) component scores. RESULTS Caregivers showed significantly greater worsening in PSS, CES‐D, and MCS, with standardized effect sizes ranging from 0.676 to 0.796 compared with changes in noncaregivers. A significant but smaller effect size was found for worsening PCS in caregivers (0.242). Taking on sustained caregiving was associated with almost a tripling of increased risk of transitioning to clinically significant depressive symptoms at follow‐up. Effects were not moderated by race, sex, or relationship to care recipient, but younger caregivers showed greater increases in CES‐D than older caregivers. CONCLUSION Persons who began substantial, sustained family caregiving had marked worsening of psychological well‐being, and relatively smaller worsening of self‐reported physical health, compared with carefully matched noncaregivers. Previous estimates of effect sizes on caregiver well‐being have had serious limitations due to use of convenience sampling and cross‐sectional comparisons. Researchers, public policy makers, and clinicians should note these strong effects, and caregiver assessment and service provision for psychological well‐being deserve increased priority.

Background and Purpose: Life’s Simple 7 (LS7) is a metric for cardiovascular health based on the 7 domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Because they may be targeted for secondary prevention purposes, we hypothesized that stroke survivors would experience improvement in LS7 score over time compared with people who did not experience a stroke. We addressed this hypothesis in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) cohort of Black and White adults enrolled between 2003 and 2007. Methods: Participants who had LS7 data at baseline, were stroke-free at baseline, had a 10-year follow-up visit, and either did not have a stroke or had an ischemic stroke >1 year before follow-up were included (N=7569). Among these participants, 149 (2.0%) had an adjudicated ischemic stroke between the LS7 assessments. LS7 scores were classified as 0 to 2 points for each domain for a maximum score of 14, with higher scores representing better health. Multivariable linear regression was used to test the association of ischemic stroke with change in LS7 score. Covariates included baseline LS7 score, age, race, sex, education, and geographic region. Results: The 149 stroke survivors had an average of 4.9 years (SD=2.5) of follow-up from the stroke event to the second LS7 assessment. After adjusting for covariates, participants who experienced an ischemic stroke showed 0.28 points more decline in total LS7 score ( P =0.03) than those who did not experience a stroke. Conclusions: Stroke survivors did not experience improvements in cardiovascular health due to secondary prevention after ischemic stroke. On the contrary, they experienced significantly greater decline, indicating the need for greater efforts in secondary prevention after a stroke.