OREGON STATE UNIVERSITY

college of public health and human sciences

Among gun owners, culturally tailored suicide prevention messages work best

BEND, Ore. – Gun owners are much more receptive to suicide-prevention messages tailored to respect their rights as firearms enthusiasts than they are to messages that use language that aims to be culturally neutral, a study published last week suggests.

The research at Oregon State University-Cascades is significant because more than half of the roughly 40,000 people in the United States who take their own lives every year do so with a gun.

Past research shows that the vast majority of people with “suicidal ideation” – thoughts of killing themselves – will live meaningful, productive lives if they get past the rough patch that caused them to think about suicide.

But only 5 percent of people who attempt suicide via firearm survive; hence the need for messaging that’s effective in helping friends and family members hold onto guns while their loved ones are experiencing suicidal ideation.

The researchers conducted interviews in 2015 with 39 adult gun owners from rural communities in central Oregon. The goal was to understand the culture of gun ownership and learn about acceptable, non-threatening methods of improving firearm safety that respect the rights of gun owners while also helping suicidal patients stay safe.

The interviews led to a one-page suicide prevention message that encouraged restricting firearm access and also respected the cultural values and rights of gun owners; the opening, for example, read “People who love guns, love you. For many of us, firearms are an American way of life – a constitutional right and a necessity in order to protect ourselves and our families. And with this right to bear arms comes responsibility. Just as we must refuse to be a victim of violent crime, we must also use common sense.”

The culturally tailored message was then used as part of a nationwide survey of more than 800 gun owners to determine the likelihood of it causing owners of firearms to engage in multiple key gun safety behaviors for suicide prevention – such as asking a suicidal person to give away his or her guns temporarily to another trusted individual.

Survey participants were randomly assigned to receive one of four messages: a control message that read only, “Mental health and suicide prevention are important public health issues”; a standard, one-page message explaining that suicide is preventable, what the warning signs are, and how to take action; the culture-specific message that resulted from the interviews with gun owners; and a message that combined the tailored message with the standard message.

“Respondents who received our culturally specific message in conjunction with standard suicide prevention content reported the greatest likelihood of taking steps to restrict access to firearms for those deemed at risk of suicide,” said OSU-Cascades anthropologist Elizabeth Marino. “This tendency was enhanced for individuals who were more politically conservative, lived in more rural areas, and supported gun rights to a stronger degree.

“The findings underscore the importance of cultural factors in public health messaging,” she said. “Messaging that respects the values of gun owners could hold promise in promoting firearm safety for suicide prevention. It’s important to understand what matters most to people and not use language that inadvertently promotes values or judgments that are not meaningful to the group you’re trying to reach.”

In this case, inadvertent promotion could come via words or sentences that suggested an anti-firearm bias.

The study found the standard one-page public health message was no more effective in moving people’s attitudes than the one-sentence control message, which was effectively no message.

“Information by itself isn’t changing minds at all,” Marino said. “But if the language in the message is sensitive and respects culturally specific values, then people are more open to the information and will maybe change their decisions. In such politically and culturally divisive times, it’s especially worth noting that there are in fact joint goals that people with diverse perspectives can talk about and reach consensus on as long as we understand each person’s cultural framework.”

Marino said one of the findings from the informational interviews was that many gun owners are already intervening when necessary by temporarily limiting access to firearms when someone is suicidal.

“This really speaks toward understanding the coping strategies and resilience in communities to solve problems and find ways to build on those,” she said. “We based our message on what people are already doing.”

Joining Marino in the study were two OSU-Cascades colleagues, psychologist and corresponding author Christopher Wolsko and public health specialist Susan Keys, as well as Holly Wilcox of Johns Hopkins University. The La Pine Community Health Center and its medical director, Laura Pennavaria, also collaborated on the study.

“That interdisciplinary perspective really helped us pay attention to the cultural framework from which all of these attitudes and actions emerge,” Marino said. “There are more deaths by suicide than deaths by car accidents every year in the U.S., and suicide is the No. 1 means of violent death globally. It’s a really important, pressing issue nationally and internationally.”

Marino notes that often someone will make the decision to take his or her life, and then act on it, inside a five-minute window.

“People believe if someone wants to kill himself or herself, they will just eventually do it, but that’s actually not the case,” she said. “If we can help them get past the rough patch, chances are great that people will survive. They go on to lead full, meaningful lives.”

The University of Rochester’s Injury Control Research Center for Suicide and the Oregon Health Authority supported this research.

Findings were published last week in Archives of Suicide Research.

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Steve Lundeberg, 541-737-4039

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Vitamin E-deficient embryos are cognitively impaired even after diet improves

CORVALLIS, Ore. – Zebrafish deficient in vitamin E produce offspring beset by behavioral impairment and metabolic problems, new research at Oregon State University shows.

The findings are important because the neurological development of zebrafish is similar to that of humans, and nutrition surveys indicate roughly 95 percent of women in the U.S. have inadequate intakes of this critical micronutrient.

The problem may be exacerbated in women of child-bearing age who avoid high-fat foods and may not have a diet rich in oils, nuts and seeds, which are among the foods with the highest levels of vitamin E, an antioxidant necessary for normal embryonic development in vertebrates. 

Corresponding author Maret Traber and collaborators at OSU compared offspring from fish on vitamin E-deficient diets – the E-minus group – with those on vitamin E-adequate diets, the E-plus fish.

The E-minus embryos had more deformities and greater incidence of death as well as an altered DNA methylation status through five days after fertilization; five days is the time it takes for a fertilized egg to become a swimming zebrafish.

For the next seven days, all of the normal-looking fish, irrespective of diet history, were fed a vitamin E-adequate diet.

Both groups grew normally and showed similar DNA methylation, but the E-minus fish failed to learn and were afraid. They also continued to have metabolic defects and indications of mitochondrial damage.

Because insufficient vitamin E reached the E-minus embryos’ brains, those brains continued to lack choline and glucose and simply did not develop correctly, said Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute.

“They managed to get through the critical period to get the brain formed, but they were stupid and didn’t learn and didn’t respond right,” Traber said. “They had so much oxidative damage they essentially had a screwed-up metabolism. These outcomes suggest embryonic vitamin E deficiency in zebrafish causes lasting impairments that aren’t resolved via later dietary vitamin E supplementation.

“What that means for people is that many people are walking around with inadequate intakes, and how is their metabolism being affected and especially the brain, which is highly polyunsaturated and has specific mechanisms for retaining vitamin E? It takes awhile to get vitamin E into the brain to protect it, and this has me concerned about teenage girls who eat inadequate diets and get pregnant.”

Traber said a lack of vitamin E causes a chain reaction that dramatically changes cell metabolism.

“It’s the secondary ripples of having inadequate vitamin E that are really causing the problems, and it takes a fair amount of time to correct all of those things that go wrong,” she said. “It’s very frightening is what it really comes down to.”

Traber’s collaborators included OSU colleagues Melissa McDougall, Jaewoo Choi, Lisa Truong and Robert Tanguay.

Findings were recently published in Free Radical Biology and Medicine. The National Institutes of Health and the National Institute of Environmental Health Sciences supported this research.

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Steve Lundeberg, 541-737-4039

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Maret Traber, 541-737-7977
maret.traber@oregonstate.edu

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Special Olympians will help OSU researchers gain further health insights

CORVALLIS, Ore. – More than 2,000 athletes will descend on Corvallis on July 8 and 9, competing in the Special Olympics Oregon Summer State Games while also helping to further research into the health of people with intellectual disabilities.

“There still is this misconception that if you have a disability, then you cannot be healthy,” said Gloria Krahn, the Barbara Emily Knudson Endowed Chair in Family Policy Studies at Oregon State University. “I would’ve thought that after 25 years, we would be past some of that. Special Olympics is helping bring about that change.”

Oregon State is hosting the Summer State Games, which feature track and field, bocce, golf and softball, with events split between Corvallis High School and the OSU campus.

Special Olympics Oregon’s Healthy Athletes program will also be part of the Summer State Games, providing free health screenings for the athletes. The screenings involve six areas called Fit Feet, FUNfitness, health promotion, Healthy Hearing, Opening Eyes and Special Smiles. Strength, flexibility, balance and endurance will be tested, and athletes will be given a take-home program based on their results that aims to improve and encourage their participation in sports and recreational activities.

Special Olympics Oregon regularly hosts Healthy Athletes programs around the state.

Special Olympics Oregon also provides a program called Oregon Team Wellness for those with intellectual disabilities. The program incorporates incentives and rewards to reach benchmarks, with the ultimate goal of lifelong healthy choices and habits.

The program, which started in Oregon, has spread to other states in the Northwest. Researchers at OSU, including Alicia Dixon-Ibarra, a post-doctoral scholar in OSU’s College of Public Health and Human Sciences, and Krahn, are working with Special Olympics to evaluate the program.

Dixon-Ibarra is working on the research and practical side of the games.

She will gather information used in research designed to further improve the health of people with intellectual disabilities. All the information from the weekend will go into one of the largest data sets for people with intellectual disabilities in the world, and can show discrepancies between different countries and their health issues. One area of the world could have issues relating to tooth decay, for example, while another may have higher rates of obesity.    

“I find this job really rewarding,” Dixon-Ibarra said. “I know there’s a huge need for health care and health promotion for this population based on my own research and the research of others in my area, and that this is a big need that we’re fulfilling with these programs.”

Dixon-Ibarra said a common misconception is that people with intellectual disabilities can’t be as healthy as those without. Also, Krahn notes that until relatively recently, trying to keep a person with a disability active and healthy fell solely on the family, without much help from school districts or other groups that organize sports and other recreational activities.

Helping to change attitudes, the researchers say, are programs like the Special Olympics, founded by Eunice Kennedy Shriver in 1968. From a small beginning – just 1,000 athletes competed in the first Special Olympics World Games – the Special Olympics are now in 169 nations and encourage more than 4 million people with developmental disabilities to be active and healthy. Shriver will be posthumously honored for her work on July 12 at the 25th annual ESPYS on ABC. 

Athletes and coaches will stay in OSU residence halls during the Summer State Games. Parking is free around Reser Stadium, and admission is free to all events. The public is invited to watch the athletes compete, and a complete schedule of the events can be found here.

People interested in volunteering with the Special Olympics Oregon Summer State Games should contact LouAnne Tabada, senior director of volunteer services for Special Olympics Oregon, at Itabada@soor.org or volunteer@soor.org.    

Media Contact: 

Lanesha Reagan, 425-359-3054

Participants sought for study on family dogs and physical activity for kids with disabilities

CORVALLIS, Ore. – Oregon State University researchers are recruiting children with disabilities and their family dogs for a research study that will test a new intervention to see if pairing the dog and the child can help the child become more physically active.

The project is led by Megan MacDonald of OSU’s College of Public Health and Human Sciences and Monique Udell of OSU’s College of Agricultural Sciences. The researchers recently received a two-year, $375,000 grant from the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development to support the project.

Children with disabilities spend less time participating in physical activity compared to their peers and are considered a health disparity group, meaning they generally face more health concerns than their peers. And physical activity tends to drop among all children around age 12. The goal of the study is to see if the partnership with the family dog leads to improvements in children’s physical activity levels, which in turn could lead to other health improvements.

“We need to find creative ways to engage kids in physical activity,” MacDonald said. “And beyond physical activity, animal companionship can have a significant impact on health and well-being.” 

The new study builds on the researchers’ earlier work exploring how a family dog might serve as a partner to help a child with disabilities become more active. In a recent case study of one 10-year-old boy with cerebral palsy and his family’s dog, the researchers found the intervention program led to a wide range of improvements for the child, including physical activity as well as motor skills, quality of life and human-animal interactions. They also found that the dog’s behavior and performance on cognitive and physical tasks improved alongside the child’s.

The new intervention is aimed at children with disabilities who are 10 to 16 years old and have a family dog that also could participate in the study. The children will learn how to train their dog in new behaviors with the “Do As I Do” method, which uses positive reinforcement. “Do As I Do” is similar to the game “Simon Says,” in which the dog follows the lead of the child.

“It’s really about the child and the dog being active together as a team,” MacDonald said. “The program also could help the relationship between the child and the dog grow.”

Families will come to OSU for one hour daily for two weeks during the study, which is expected to begin later this summer. There is some flexibility to the schedule depending on families’ needs. The children also will have homework such as walking the dog each day at home. Not all families selected for the study will participate in the “Do as I Do” training this year but all families will have a chance to participate in the training over the course of the two-year study.

“Participating children need to be able to follow basic instructions but beyond that, we want to be as inclusive as possible,” MacDonald said. “Parents who have questions about whether their child and their pet are a good fit for the study should feel free to give me a call so we can discuss their individual needs.”

Families interested in learning more about the study or participating in it should contact MacDonald at 541-737-3273 or Megan.MacDonald@oregonstate.edu

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Michelle Klampe, 541-737-0784

Want to better comply with dietary guidelines, and save money? Cook dinner at home

CORVALLIS, Ore. – The best culinary paths to better health are not always paved with cash, new research shows, and cooking at home can provide the best bang-for-the-buck nutritionally as well as  financially.

A study by Arpita Tiwari, a health systems researcher at Oregon State University, and collaborators at the University of Washington confirms what many mothers and grandmothers have said for decades: that habitually eating dinner at home means a better diet and lower food expenditures compared with regularly dining out.

“Traditionally better socioeconomic status – more money – means healthier people,” said Tiwari, a graduate student at OSU's College of Public Health and Human Sciences. “That’s the trend. This research goes against that; it shows a resilience to that trend. It’s not spending more but how you spend that’s important. What you eat is important.”

“Cooking at home reduces that expenditure, and our research empirically quantifies that when we regularly eat dinner at home, our nutrition intake is better.”

Tiwari is quick to point out, though, that researchers understand the barriers to home-cooked meals.

“A mother who has two jobs and four children, even if she knows the value of home-cooked dinners, doesn’t have time to cook,” Tiwari said. “Government policy needs to be mindful of things like that when states create programs to help Medicaid populations achieve nutritional goals. Right now our system really does not allow for it. What can the government do about that? That’s what needs to be explored in the near future.”

The research involved more than 400 Seattle-area adults who were surveyed regarding a week’s worth of cooking and eating behaviors. Participants also provided various types of sociodemographic information, and their weekly food intake was graded using the Healthy Eating Index (HEI).

HEI scores range from 0 to 100, with higher scores indicating better diet quality. An index score over 81 indicates a “good” diet; 51 to 80 means “needs improvement”; and 50 or less is “poor.”

Households that cooked at home three times per week showed an average score of about 67 on the Healthy Eating Index; cooking at home six times per week resulted in an average score of around 74.

“Higher HEI scores are generally associated with higher socioeconomic status, education and income,” Tiwari said. “By contrast, cooking dinner at home depends more on the number of children at home. The study showed no association between income or education and eating at home or eating out.”

The findings also suggested that regularly eating home-cooked dinners, associated with diets lower in calories, sugar and fat, meant meeting more of the guidelines for a healthy diet as determined by the Department of Agriculture.

Eighty percent of U.S. residents fail to meet at least some of the federal dietary guidelines, the study notes, and about half the money spent on eating in the U.S. is on food not cooked at home. From the 1970s to the late 1990s, the percentage of home-cooked calories consumed fell from 82 to 68.

“HMOs should have ancillary programs to really encourage people to eat healthier,” Tiwari said. “It’s a benefit for insurance companies to get involved; eating is really the source of most of the issues that the insurance system has to deal with down the road.”

The National Institutes of Health supported this research. Findings were published in the American Journal of Preventive Medicine.

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Steve Lundeberg, 541-737-4039

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Study examines impact of common risk factors on outcomes for home and birth center births

CORVALLIS, Ore. – Women with some characteristics commonly thought to increase pregnancy risks – being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section – tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes.

About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.  

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico.

Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth.

“These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.

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Melissa Cheyney, 541-737-4515, melissa.cheyney@oregonstate.edu; Marit Bovbjerg, 541-737-5313, Marit.Bovbjerg@oregonstate.edu

Adolescents with frequent PE more fit, more informed about physical activity’s role in health

CORVALLIS, Ore. – Frequent, long-term instruction in physical education not only helps adolescents be more fit but also equips them with knowledge about how regular physical activity relates to good health, research at Oregon State University shows. 

The findings are important for several reasons. One is that regular physical education, which is on the decline nationwide, strongly correlated with students meeting the federal recommendation of at least 60 minutes per day of moderate to vigorous physical activity.

The results also showed more than one adolescent in five reported no physical education at all; nearly 40 percent of the students in the 459-person sample, whose ages ranged from 12 to 15, were obese or overweight; and only 26.8 percent met the federal government’s physical activity guidelines.

“Perhaps some were not meeting the guidelines because fewer than 35 percent actually knew what the guidelines were for their age group,” said study co-author Brad Cardinal, a professor in OSU’s School of Biological and Population Health Sciences and a nationally recognized expert on the benefits of exercise.

The guidelines call for an hour or more of physical activity at least five days a week.

The findings by OSU’s College of Public Health and Human Sciences indicate that a trend of decline in physical education mandates for middle-school students is detrimental to developing the knowledge, interests and skills that serve as a foundation for a lifelong healthy lifestyle.

Physical activity also has been shown to improve cognitive function and academic performance, Cardinal said.

“We have the physical activity guidelines for a reason, and they’re based on good science,” he said. “With only slightly more than one in four adolescents meeting the guidelines, today’s youth are being shortchanged in terms of their holistic development. They are not being prepared to live the proverbial good life.”

Cardinal notes that new guidelines will be released in 2018.

“Because of a growing propensity toward inactivity in daily life, such as increased media consumption and screen time, the guidelines very well may have to be ratcheted up to compensate,” Cardinal said.

Like physical education, participation in sports also correlated with more accurate student perceptions of the amount of physical activity necessary for good health, as well as better performance on a variety of muscular fitness-related tests.

“This underscores the importance of quality physical education in schools and the added value of sports participation,” Cardinal said. “The junior high/middle school years are a vulnerable and pivotal time in which students are typically required to take at least some physical education for at least part of the year, whereas after their freshman year in high school, most students aren’t required to take any. It’s a time when experiences in physical education and sports, whether positive or negative, can make or break whether an adolescent chooses to continue a physically active lifestyle.”

Cardinal points out that in Oregon, 2017 is supposed to represent the final year in a decade-long, statute-mandated ramp-up of physical education in public schools, but the reality is something different.

Portland Public Schools, he noted, just announced a cutback to 30 minutes of physical education every other week, whereas the law calls for 225 minutes per week for middle school students and 150 for elementary school students.

“In the federal Every Student Succeeds Act, physical education is a core subject, on par with language, math and science. Its status was elevated for a reason,” Cardinal said. “If you’re physically active, you’re going to be healthier and stronger and have fewer behavioral problems, and your cognitive function is going to be better.

“Physical education trumps sports in a head-to-head comparison of the two,” he added, “and when you have physical education plus sports, that’s when you have students who are the healthiest, fittest, strongest and most active.”

Findings were published in the American Journal of Health Promotion.

OSU alumnus Paul Loprinzi, now with the University of Mississippi, is the lead author, and the other co-authors are Marita Cardinal of Western Oregon University and Charles Corbin of Arizona State University.

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Steve Lundeberg, 541-737-4039

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Social media tools can reinforce stigma and stereotypes

CORVALLIS, Ore. – Researchers at Oregon State University have developed new software to analyze social media comments, and used this tool in a recent study to better understand attitudes that can cause emotional pain, stigmatize people and reinforce stereotypes.

In particular, the scientists studied comments and sentiments expressed about Alzheimer’s disease and other forms of dementia. It found that 51 percent of tweets by private users of Twitter accounts contained stigma, when making reference to this condition and the people who deal with it.

The new system may be applicable to a range of other social science research questions, the researchers said, and already shows that many people may not adequately appreciate the power of social media to greatly transcend the type of interpersonal, face-to-face communication humans are most accustomed to.

“As a society it’s like we’re learning a new skill of text communication, and we don’t fully understand or reflect on its power to affect so many people in ways that we may not have intended,” said Nels Oscar, an OSU graduate student in the College of Engineering and lead author on the study.

“Social media is instant, in some cases can reach millions of people at once, and can even instigate behaviors. We often don’t even know who might eventually read it and how it will affect them.”

What’s clear, the study showed, is that when it comes to Alzheimer’s disease, thoughtless or demeaning comments on a broad level via social media can take an already-serious problem and make it worse.

The particular topic studied, the scientists said, is of growing importance. A global tripling of individuals with some form of dementia is projected in coming decades, from 43 million today to 131 million by 2050.

“It was shocking to me how many people stigmatized Alzheimer’s disease and reinforced stereotypes that can further alienate people with this condition,” said Karen Hooker, holder of the Jo Anne Leonard Petersen Endowed Chair in Gerontology and Family Studies, in the OSU College of Public Health and Human Sciences. “This can create what we call ‘excess disability,’ when people with a stigmatized condition perform worse just because of the negative expectations that damaging stereotypes bring.

“This type of stigma can make it less likely that people will admit they have problems or seek treatment, when often they can still live satisfying, meaningful and productive lives. Our attitudes, the things we say affect others. And social media is now amplifying our ability to reach others with thoughtless or hurtful comments.”

The researchers noted a 2012 report which concluded that negative attitudes about Alzheimer’s disease and dementia can result in shame, guilt, hopelessness, and social exclusion among stigmatized individuals, leading to delay in diagnosis, inability to cope, and decreased quality of life. It also affects friends, family and caregivers of these individuals.

A comment a person might never make in a face-to-face conversation, Oscar said, is often transmitted via social media to dozens, hundreds or ultimately thousands of people that were not really intended. Some constraints that might reduce the impact, like clearly making a joke or using sarcasm in a personal conversation, can often get lost in translation to the printed word.

“A point many people don’t understand when using social media is that their intent is often irrelevant,” Oscar said. “All people eventually see is the comment, without any other context, and have to deal with the pain it can cause.”

This research was one part of a six-year, $2.3 million project funded by the National Science Foundation to train graduate students in aging sciences and to conduct cross-disciplinary studies on issues of importance to an aging society. The paper was recently published in the Journals of Gerontology: Psychological Sciences. The software created for the project is now freely available for other scientists to use, at http://bit.ly/2p5GmDC

In the research, the software was designed to recognize and interpret the use of various keywords associated with Alzheimer’s disease, such as dementia, memory loss or senile. The system was improved by comparing results to the same comment evaluated by human researchers, and ultimately achieved an accuracy of about 90 percent in determining whether a comment was meant to be informative, a joke, a metaphor, ridicule, or fit other dimensions.

The system was then used to analyze 33,000 tweets that made some reference to Alzheimer’s disease.

People concerned about these issues, the OSU researchers suggested, might be more conscious of their own comments on social media, and also more willing to engage with others who are using language that is insensitive or potentially hurtful.

“We should also consider ways to combat stigma and negative stereotypes by tweeting about the positive experiences of persons with dementia and people in their social networks,” Hooker said.

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Karen Hooker, 541-737-4336

hookerk@oregonstate.edu

Elevated blood pressure not a high mortality risk for elderly with weak grip

CORVALLIS, Ore. – A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.

New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders’ frailty status as measured by walking speed.

The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.

“If people are very frail, they typically don’t respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure,” said lead author Chenkai Wu, a graduate student in OSU’s College of Public Health and Human Sciences. “The research is basically saying older adults are not one single group, they’re very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don’t just look at age, you look at other things like functional status.”

Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.

Most people’s diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure – hypertension – can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.

But as Wu’s research suggests, an elderly patient’s level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.

Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.

Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.

The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.

“We did three analyses,” Wu said. “One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength – weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.

“Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial.”

OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.

“As we age, our blood vessels lose elasticity and become stiff,” said Odden, an assistant professor in the College of Public Health and Human Sciences. “Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.

“And everyone ages differently – there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process.”

In addition to the connection with weak grip strength, Wu said there was a “very clear” inverse association between high blood pressure and mortality among those who weren’t physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.

Put another way, among those who couldn’t walk a little over 8 feet, high blood pressure was associated with less mortality risk.

“It’s a small group but not negligible – 6 percent – of people who were not able to complete the test,” he said. “Compared to grip strength, it’s a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc.”

The National Institute on Aging supported this research. Findings were recently published in the Journal of the American Geriatrics Society.

Ellen Smit, associate professor of epidemiology in the College of Public Health and Human Sciences, served as a co-author.

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By Steve Lundeberg, 541-737-4039

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Oregon high schools lacking ‘best practices’ for athletic emergencies

CORVALLIS, Ore. – A survey of Oregon high school athletic directors on their school’s preparedness for a catastrophic injury or health event found that only 11 percent of those responding had implemented three primary “best-practice” recommendations for treating their student-athletes.

Multiple national sports safety organizations have defined institutional best practices, including having a plan in place for when emergencies occur and ensuring the training and accessibility to the proper equipment for those who respond. 

Results of the research have been published in Sports Health, a collaborative publication of the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the National Athletic Trainers’ Association and the Sports Physical Therapy Section.

“We launched the survey to gauge how prepared schools are to respond to athletic-related emergencies,” said Samuel Johnson, an athletic training and kinesiology specialist at Oregon State University and lead author on the study. “We also wanted to know if having an athletic trainer – a health care professional with expertise in sports medicine – available at the school was associated with better preparedness.” 

The researchers asked whether schools had venue-specific emergency action plans, had access to an automated external defibrillator (AED) for early defibrillation in the event of an emergency, and whether they required first responders – specifically coaches – to be trained in cardiopulmonary resuscitation and proper use of an AED.

The OSU-led study found that 29 percent of schools responding to the survey had implemented two of the three best-practice recommendations; 32 percent had implemented one recommendation; and 27 percent had not implemented any of them. The survey received 108 responses, or about 37 percent of all Oregon high schools. 

“There is definitely room for improvement in planning for medical emergencies,” he said. “We are doing some things well in the state, and there are things we need to do better. For example, having an AED available on campus is a great first step, but we need to make sure it is readily available at athletic events and that people are trained to use it.”

Only half of the schools in the study had an athletic trainer available, yet Johnson said having one was associated with better preparedness. 

“Athletic trainers are specifically trained to prevent and respond to emergencies,” Johnson noted. “We found that having an athletic trainer on staff was associated with better preparedness, particularly as it relates to emergency plans and having AEDs on hand. However, having an athletic trainer was not associated with whether schools required coaches to have training in CPR or with a defibrillator.”

Johnson pointed out that while athletic trainers likely are not in a position to mandate that coaches having training, they can take charge in making sure plans are in place and potentially life-saving equipment is available when needed. 

“We understand several of the challenges associated with implementing some of the recommendations,” Johnson said. “Buying AEDs, paying for coach training, or hiring an athletic trainer can be expensive. Budgets are tight and catastrophic medical situations are rare. But they do happen, and they have a devastating impact on the athlete, family and friends.”

The researchers are planning to explore the challenges schools face in implementing best practices. The Oregon School Activities’ Association, which governs high school sports in the state, has been proactive in promoting sports safety, Johnson said. 

“I am always impressed by how well the different groups in the state come together to make sports safer,” said Johnson, who along with several of the study’s co-authors are members of the OSAA’s Sports Medicine Advisory Committee. “The OSAA has been a driving force in getting coaches, athletic directors, athletic trainers, physicians and other stakeholders talking about these issues and making changes to improve safety.

“For example, starting this year there is a requirement that schools have an emergency action plan for athletics. These collaborative efforts don’t happen in every state, though they probably should.” 

Johnson, who is in the College of Public Health and Human Sciences at OSU, is taking the message outside of Oregon. He will address a worldwide audience of sports medicine professionals on preparedness at the International Olympic Committee’s World Conference on Prevention of Injury and Illness in Sport later this year.

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Sam Johnson, 541-737-6801, sam.johnson@oregonstate.edu