BACKGROUND:Addressing the growing child and adolescent mental health crisis is a global priority, particularly in low- and middle-income countries (LMICs). Although the literature demonstrates that experiencing maltreatment may negatively impact mental well-being and experiencing social support may positively impact mental well-being, the relationship between mental well-being and co-occurring maltreatment and social support is unknown. OBJECTIVE:This study examined the relationship between maltreatment, social support, and mental well-being. PARTICIPANTS AND SETTING:Study data is from the longitudinal Positive Outcomes for Orphans (POFO) study of orphaned and separated children and youth/young adults (OSC) (n = 2535) from five LMICs (Cambodia, Ethiopia, India, Kenya, and Tanzania). METHODS:We used bivariable analyses to calculate relationships between 1) mental well-being and maltreatment and 2) mental well-being and social support. Then, we used generalized linear models (GLMs) to examine relationships between 1) mental well-being and maltreatment, 2) mental well-being and social support, and 3) mental well-being, maltreatment, and social support. Models were controlled for age, gender, health, parental status and other traumas. RESULTS:Maltreatment was associated with increased well-being difficulties (Coeff = 2.068, SE = 0.249, CI = 1.579-2.559), while social support was associated with decreased well-being difficulties. In a GLM examining social support and maltreatment, social support reduced well-being difficulties (Coeff = -0.137, SE = 0.010, CI = -0.157- -0.119), even in the concurrent presence of maltreatment (Coeff = -0.131, SE = 0.010, CI = -0.151- -0.111). Three subtypes of social support were associated with reduced mental well-being difficulties: emotional support, tangible support, and positive social support. CONCLUSIONS:Findings indicate that measuring both maltreatment and social support may result in a more comprehensive understanding of youth emotional difficulties. Interventions that facilitate social support may promote emotional well-being and may be particularly useful in communities where trauma-informed mental health services are inaccessible.

Alzheimer's disease and related dementias (ADRD) are complex and rapidly growing public health challenges that require integrative, collaborative approaches. To meet this need, the Alzheimer's Disease Research Center (ADRC) of South Carolina, a state-funded partnership across multiple institutions, has embraced a team science model that brings together expertise from four key disciplines: neuroimaging-neurology, health sciences, molecular biology, and engineering. This paper highlights the work at the University of South Carolina (USC) and how each discipline contributes uniquely yet collaboratively within a recurring loop model framework. Extending from USC's Cancer Prevention and Control Program, the framework guides scientific growth through four iterative phases: discovery, development, delivery, and dissemination. From identifying cellular and molecular biomarkers to applying neuroimaging for early diagnosis, utilizing wearable technologies for real-time monitoring, and analyzing statewide data to understand caregiver burden and health inequities, each group contributes to a comprehensive and translational research cycle. By supporting structured mentorship, cross-disciplinary pilot projects, and shared infrastructure, the ADRC initiatives advance research that is both scientifically rigorous and equity-focused. This approach provides a valuable framework for advancing ADRD research and can inform other institutions aiming to tackle similarly complex health issues from discovery through dissemination.

IntroductionGuided by a communications-focused framework developed by an interdisciplinary team of authors, this paper presents data from a survey of health science faculty members to better understand how research collaborations are established and maintained.MethodsAn electronic survey was distributed to faculty in six colleges at a Research 1 institution. Quantitative data were downloaded into Excel and then RStudio for descriptive analysis. Open-ended, qualitative responses were coded and analyzed for themes.ResultsMost respondents were in public health (44.0%) or medicine (25.3%); 40.0% were tenured. A grant deadline was the main impetus reported for initiating research collaborations (86.1%). Most respondents (76.5%) sought federal research funding. Establishing roles at the start of collaborations was considered either extremely (74.4%) or somewhat (25.6%) valuable; most (78.0%) decided on roles in a collaborative manner. Women were significantly more likely than men to publish with community members (p < 0.001) and disseminate findings beyond journal publications or presentations (e.g., reports; p < 0.001). Individuals in public health were more likely than those in other disciplines to publish with community members (p = 0.026).DiscussionFindings suggest reaching out to collaborators to prepare a grant application no later than three months and ideally six months in advance. Expertise played a role in collaborator invitation, but personal qualities such as work ethic and enthusiasm for the research were also valued. Including and mentoring students on research teams was considered an important ingredient in research collaborations. Results should help guide efforts to establish and maintain research teams and may provide guidance to both novice and experienced researchers.

INTRODUCTION:Mortality-to-incidence ratios (MIRs) are useful in assessing disease burdens and illustrating disparities. Unlike cancer, MIRs have not been applied to ADRDs. Therefore, we estimated and mapped the MIRs for ADRDs to show disparities in South Carolina. METHODS:Using data from the South Carolina Alzheimer's Disease Registry (2017-2021), ADRD MIRs were calculated by demographic and geospatial characteristics. To account for the influence of the COVID-19 pandemic, data from 2015 to 2019 were also examined. MIRs were calculated as age-adjusted mortality rates divided by age-adjusted incidence rates. RESULTS:Overall, Black people and rural individuals consistently experienced higher MIRs, with the COVID-19 pandemic increasing this disparity gap. MIRs greater than 1.00 were only observed among Black people. The MIR for 31 out of 46 counties exceeded the state average. DISCUSSION:Estimating and mapping ADRDs has aided in identifying specific areas with the greatest burden of ADRD in South Carolina for targeting interventions.

This study uses the data collected from the “ P artnership in I mplementation S cience for G eriatric M ental H ealth (PRISM)” project, a randomized trial designed to test implementation support strategies for the delivery of the Reducing Disability in Alzheimer’s Disease (RDAD) program, an evidence-based multi-component exercise and behavioral/psychosocial intervention for older adults with dementia and their family caregivers in Thailand. A total of 353 dyads of persons with dementia (PwD) and behavioral and psychological symptoms of dementia (BPSD) and their family caregivers received a 12-week RDAD intervention and were assessed at baseline, and at 3- and 6-months post-treatment. Longitudinal analyses were conducted using paired-sample t-tests to estimate the changes in each of the outcomes by treatment groups. Paired t-tests showed that between baseline and 3 months, there were significant decreases in caregiver clinical outcomes, including caregiver burden (p = 0.047), depressive symptoms (p = 0.02), and BPSD-related caregiver distress (p < 0.001). Similarly, there were significant decreases between baseline and 3 months in PwD’s mental health indicators, including BPSD symptoms (p < 0.001), BPSD severity (p < 0.002), and depression (p < 0.001). PwDs also showed a significant increase in physical function assessed by ADLs (p < 0.031) and cognitive function, as assessed by the Thai MMSE (TMSE) (p < 0.001), and these trends persisted between the 3- and 6-month follow-up assessments, with significant increases in ADLs (p < 0.001) and TMSE (p < 0.001). We also conducted heterogeneity regression analysis to assess whether the time changes might be determined by baseline characteristics (e.g., sex, age, subgroups) and found no significant influences of these factors on changes in outcomes over time. The results suggest that the RDAD intervention significantly reduces caregivers’ psychological burden, depressive symptoms, and BPSD-related distress and also improves the PwD’s mental, physical, and cognitive function. These findings provide evidence that supports efforts to expand the reach of US-developed evidence-based non-pharmacological interventions to improve dementia care for community dwellers in resource-limited settings like Thailand.

To inform the development and adaptation of lifestyle programs to prevent type 2 diabetes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes (GDM). Participants are from the Balance after Baby Intervention (BABI) study, a two-year randomized clinical trial of a lifestyle program for women with recent GDM conducted in Boston, MA, and Denver, CO between 2016 and 2019. The Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered at an average of 8-weeks postpartum. We defined an EPDS score of ≥ 9 as depressive symptoms and reviewed medical records for medical history. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of postpartum depressive symptoms using multivariable logistic regression and selected the best fit model. Our analysis included 181 women. Thirty-five (19

Racial and ethnic disparities in end-of-life (EOL) care planning persist, particularly due to limited knowledge of culturally sensitive practices among older Vietnamese and Filipino Americans - two of the largest Southeast Asian American subgroups. To address this gap, we used a transcendental phenomenological approach to explore attitudes, barriers, and facilitators toward EOL care planning. Three virtual focus groups were conducted: one Filipino group and two Vietnamese groups (one in English, one in Vietnamese), with nine participants aged 55 or older. This study adhered to the COREQ guidelines to ensure transparency and rigor in qualitative reporting. Thematic analysis, guided by a transcendental phenomenological lens, revealed a shared belief in the importance of EOL care planning in both groups, driven by the desire to honor personal wishes, reduce burden on family, and minimize conflict. Participants also expressed distrust in healthcare systems and emphasized the influence of family dynamics on EOL decisions. Notable differences emerged: Vietnamese participants more often described cultural practices that encouraged open conversations about death, while Filipino participants cited cultural taboos that hindered such discussions. These findings underscore the need for culturally and linguistically responsive approaches to support EOL care planning in Southeast Asian American communities.

IntroductionHistorically Black Colleges and Universities have played a key role in advancing educational equity and remain essential in shaping a more inclusive and diverse research landscape. However, persistent structural barriers limit their full participation in national research priorities. There remains limited comprehensive awareness of the unique barriers and opportunities encountered by investigators within HBCUs. This study explores the experiences of investigators at HBCUs, examining the challenges and opportunities they encounter in conducting research.MethodA two-phased exploratory approach was utilized, including a qualitative content analysis of grant entries from the National Institutes of Health (NIH) and National Science Foundation (NSF) and an online survey of HBCU investigators between February 7th and April 10th, 2024.ResultsThe content analysis highlights HBCU faculty’s strong contributions to research areas of science, technology, engineering, mathematics (STEM), advanced technology and data science, environmental sciences, and health. The survey findings reveal challenges related to funding, research infrastructure, and a lack of targeted support for enhancing faculty research capabilities. Participants also highlighted several challenges, including administrative burdens, under-resourced support for research and activities, lack of funding, and the need for policy changes. Results suggest the pressing need for HBCUs to address workload balance, improve mentorship, provide professional support for grant submission, and reduce administrative burdens to increase the research productivity of investigators.DiscussionFindings reinforce a strategic role in advocating equitable research policies and institutional support structures at HBCUs. Effective central leadership and sustained institutional support are essential for HBCUs to address these challenges. These efforts are not merely a measure of faculty productivity; they also contribute to broader national goals by enhancing the future research environment and promoting inclusive excellence in higher education, particularly for underrepresented institutions.

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer’s Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary’s contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments.

We are an interdisciplinary group of colleagues dedicated to partner engagement and team science. This influences our academic work, informs our research mentorship and capacity-building initiatives with junior scholars, conditions how we communicate with individuals outside of our disciplines, and makes lifelong learning a priority for ourselves and our trainees. Using the analogy of a seven-layer cake, this paper describes our capacity-building approach to develop, engage, and sustain research teams in a manner that aligns with health and risk communication principles. While preparing for a pandemic and engaging in team-based academic research may seem like apples and oranges, they both require the same key component throughout the process that we must encourage in our mentorship practices - effective communication. We provide concrete examples from our experiences on research teams that span decades and institutions.

The number of people with Alzheimer's disease and related dementias (ADRD) in the United States is steadily increasing, with minoritized populations having a disproportionate burden of disease. One strategy to address the racial and ethnic disparities in aging is to diversify scholars in the field of aging, to increase dynamic solution development and create cultural congruence among researchers and participants. The National Institute on Aging has a committed effort to increase and diversify the number of scientists who conduct aging and ADRD research, placing a call for Centers to focus on this effort. In response to the National Institute on Aging call, the Carolina Center for Alzheimer's Disease and Minority Research, housed at the University of South Carolina, proposed a dual approach to addressing these gaps through a joint national conference and mentorship program for underrepresented minoritized faculty. After one year of the program, the participating scholars were surveyed, and successes and growth points of the program were identified to help guide the improvement of this dual approach to addressing gaps in scholar diversity in aging research.

Kinship caregivers (e.g., grandparents raising grandchildren) have been increasing over the last several decades. Approximately 3.5 million grandparents and other relatives are the primary caregivers for their related children, and African Americans are more likely to be kinship caregivers than persons from other groups. Kinship caregivers face unique challenges, such as parenting for uncertain periods of time and often with insufficient financial resources and support, placing them at significant risk of stress. Given the findings linking chronic stress to Alzheimer's disease (AD), there is a need for research to identify possible stressors and mitigate risks for outcomes such as AD among kin caregivers. Additionally, research indicates that African Americans (AAs) experience unusually high levels of stress due to factors often associated with structural racism, and they are disproportionately affected by cardiovascular disease (CVD), which is often a consequence of stress and another risk factor for AD. Regrettably, AA kin caregivers often incur a host of negative stress-related outcomes, including poor physical and mental health. Thus, there is an urgent need for research to identify modifiable risk factors for both stress and CVD to potentially mitigate the onset of AD in this population. The purpose of this paper is to provide a conceptual framework to examine the links between African Americans who commit to the unselfish act of providing kinship caregiving and their susceptibility to AD. Future research should investigate modifiable mechanisms to reduce the risks of AD in African American caregivers.

Kinship caregivers (e.g., grandparents raising grandchildren) have been increasing over the last several decades. Approximately 3.5 million grandparents and other relatives are the primary caregivers for their related children, and African Americans are more likely to be kinship caregivers than persons from other groups. Kinship caregivers face unique challenges, such as parenting for uncertain periods of time and often with insufficient financial resources and support, placing them at significant risk of stress. Given the findings linking chronic stress to Alzheimer’s disease (AD), there is a need for research to identify possible stressors and mitigate risks for outcomes such as AD among kin caregivers. Additionally, research indicates that African Americans (AAs) experience unusually high levels of stress due to factors often associated with structural racism, and they are disproportionately affected by cardiovascular disease (CVD), which is often a consequence of stress and another risk factor for AD. Regrettably, AA kin caregivers often incur a host of negative stress-related outcomes, including poor physical and mental health. Thus, there is an urgent need for research to identify modifiable risk factors for both stress and CVD to potentially mitigate the onset of AD in this population. The purpose of this paper is to provide a conceptual framework to examine the links between African Americans who commit to the unselfish act of providing kinship caregiving and their susceptibility to AD. Future research should investigate modifiable mechanisms to reduce the risks of AD in African American caregivers.

This brief report provides an overview of lessons learned through evaluation of the first five years of the NIA-funded South Carolina-Advancing Diversity in Aging Research (SC-ADAR) undergraduate program, whose goal is to increase the number of qualified underrepresented minority (URM) students who pursue scientific graduate studies in programs focusing on medicine, science, technology, engineering, and mathematics and aging. Partnering with five Historically Black Colleges and Universities in South Carolina, we implemented a research training approach that included two consecutive summers of research training in a University of South Carolina faculty laboratory, as part of a comprehensive 24-month research education program. In addition to the mentored research experience in a laboratory, students had coursework in the biology of aging and social gerontology, with additional workshops tailored to emergent student needs including basic academic skills development, work-life management skills, reflective social experiences, and enhanced support in the transition from undergraduate to graduate school. We provide an overview of lessons learned throughout the early program period, and a description of the iterative changes we made in the program in response to this learning, all of which have been incorporated into the existing SC-ADAR program.

Abstract Introduction Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study. Methods We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM. Results Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal. Discussion Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM.

COPYRIGHT © 2023 Chen, Levko , Kort, McCollum and Ory. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Technological innovations to address social isolation and loneliness in older adults

Abstract Advance directives (ADs) are legal documents that enable individuals to communicate their end-of-life care preferences in advance. AD completion is associated with decreased likelihood of unwanted medical interventions, healthcare costs, and decisional burden for family members. Compared to older Americans in general, older Asian Americans are less likely to complete ADs. While research focusing on ADs among Asian Americans has grown, few have investigated attitudes toward ADs among older Southeast Asian Americans (SEAAs). The study addresses that gap by examining factors associated with attitude toward ADs among older SEAAs. Using convenience sampling from 12 community partners and snowball sampling, we recruited 251 participants aged 55 and older who self-identified as Vietnamese (n=113), Filipino (n=100), or Indonesian (n=38) Americans. Through online or in-person questionnaires, participants completed the Nolan and Bruder’s Advance Directive Attitude Survey, which measures attitudes toward ADs. Responses are rated on a 4-point Likert scale, with higher scores indicating more positive attitudes. In general, Indonesian (mean=3.40, SD=0.55) and Filipino (mean=3.40, SD=0.68) Americans expressed significantly more positive attitude toward ADs than Vietnamese (mean=3.15, SD=0.56) Americans. Results of ordinary least squares regression showed that family cohesion, expectation of intergenerational support, depression, and resilience were positively associated with attitude toward ADs, whereas death anxiety was negatively associated with attitude toward ADs. By enhancing understanding of SEAAs’ attitudes towards ADs, these results can inform culturally appropriate interventions to improve AD implementation among SEAAs and contribute to broader awareness of and access to end-of-life care services in this population.

Abstract Research has demonstrated a lack of understanding around the significant disparities in end-of-life (EOL) care decisions and culturally sensitive EOL care practices among older Southeast Asian Americans (SAA). Little is known regarding the factors related to the experiences and attitudes toward family involvement in EOL care, especially among these populations. This study explored how family relationships shape attitudes towards and experiences of family involvement in EOL care among older Vietnamese American and Filipino Americans. Three focus groups consisting of one Filipino group (in English), and two Vietnamese groups (one in English, one in Vietnamese) were held with 12 participants aged 55 or above. Interview questions centered around EOL care preferences and experiences and the role of family relationships in EOL care. Participants reported they could trust their children the most with their EOL care wishes, and expressed the preferred place for EOL care to be “home” rather than institutional settings. While some reflected that previous experiences with older family members (e.g., parents, aunts and uncles) facilitated EOL care discussions, others acknowledged resistance from some in participating in these conversations. Cultural and language differences led to participants’ resistance to formalized care and hindrances to EOL care planning. Finally, financial cost, concern about burdening younger generations who “have their own lives”, and difficulty navigating information were cited as barriers to EOL care. Findings from this study can provide improved understanding of the role that family plays in individuals’ EOL care experiences and improve culturally responsive EOL care practices for SAA populations.

There is widespread agreement about the need for strengthening the dementia-capable workforce to increase the accessibility of online dementia care training programs for paid care workers (PCW) in LTC. Through three NIH-funded research projects, we are forming an approach to the development of digital dementia training interventions based on two main strategies: a) improving ‘engage-ability’ by using an engagement design centering on the concepts of motivation (key needs of the user), satisfaction (positive experience with the intervention), and interactivity (connection from one session to another); and b) integrating domain-specific employee training with a generic employee wellness program. Study 1 evaluates a self-directed learning (SDL) digital dementia care training intervention to increase ‘engage-ability’ by addressing PCWs’ needs for improved knowledge and competence for caregiving while maintaining a sense of control in the learning process (motivation); by enhancing the ease of use through scenario-based audiovisual modules (satisfaction); and, by using post-session quizzes and pre-session reminder messages (interactivity). Study 2 developed a worksite digital health risk assessment combined with a wellness improvement program that enabled a workplace counselor to deliver health education materials to increase healthy lifestyle behaviors in preretirement adult workers aged 55 and above. Study 3 combines the SDL dementia care training with the wellness program for PCWs in LTC settings in order to achieve high ‘engage-ability’ and acceptability of the intervention. A pre-post evaluation of the SDL program (Study 1) revealed a significant reduction in stress and improved self-efficacy in providing dementia care among PCWs (Study 1). Formative research demonstrated moderate usability and acceptability from the pre-retirement workers who participated in Study 2. In Study 3, focus groups with PCWs and managers from LTC organizations showed high endorsement of integrated dementia care training and wellness programs with organizational support for the delivery of the training intervention for PCWs in LTC settings. A successful digital training program for PCWs providing dementia care in LTC systems requires an integration of dementia-specific training and the tools for wellness critical for supporting PCWs’ overall well-being while securing support from the LTC organizations for PCW participation in the program.

This study aims to examine the (a) prevalence of adverse childhood experiences (ACEs) among children in kinship care; (b) relationships between the number and type of ACEs and children’s internalizing and externalizing problems; and (c) moderating role of kinship caregivers’ mental health on the relationships between ACEs and children’s internalizing and externalizing problems. A sample of children in kinship care ( N = 224) obtained from the National Survey of Child and Adolescent Well-Being II was used. Ordinary least squares regression models were conducted. Results indicated that neglect followed by parental substance abuse were found to be the most prevalent of the ACEs. Child neglect, sexual and emotional abuse, and parental substance abuse were significantly associated with child internalizing problems, whereas sexual and emotional abuse were significantly associated with child externalizing problems. The total number of ACEs and experiencing three or more ACEs were significantly associated with child externalizing problems. Kinship caregivers’ mental health significantly moderated the relationships between neglect, sexual abuse, and child internalizing problems. Caregiver’s mental health also moderated the relationships between emotional and sexual abuse, neglect, and children’s externalizing problems. Findings suggest the importance of addressing ACEs and the need for mental health services to both kinship caregivers and children in kinship care.