The Role of Social Networks on Depressive Symptoms: A Comparison of Older Koreans in Three Geographic Areas

The purpose of this study was to examine the correlates of depressive symptoms among older Korean adults in three geographic locations with varying densities of the Korean population: mainland Korea (mostly Koreans), New York metropolitan area (high Korean density), and west central Florida (low Korean density). The study focused on the role of family and friend networks. Data were drawn from three sources: (1) a multistage national sample of Koreans in South Korea (n = 403); (2) a survey conducted in the western/central Florida area that used a variety of culturally sensitive sampling strategies (n = 672); and (3) a survey in the New York metropolitan area (n = 420) that replicated the Florida study. For those living in Korea, living alone and lower perceived financial status were independently associated with higher levels of depressive symptoms. For the New York and Florida samples, fair or poor self-rating of health, lower levels of acculturation, and weaker ties with family were related to higher levels of depressive symptoms. Similar to the older Korean sample, lower perceived financial status was linked with greater depressive symptoms in the New York sample. The overall results suggest that it is important to consider the interplay of the social network, personal, and cultural resources when working with older adults in diverse contexts. Intervention efforts should address mental health issues tailored to cultural and social settings.

PHYSICAL-MENTAL-ORAL-COGNITIVE HEALTH IN OLDER KOREAN AMERICANS: A MULTISITE STUDY

Using data from surveys with older Korean Americans (n = 2,150) conducted at five sites in the U.S. (California, New York, Texas, Hawaii, and Florida), the present study explored the status of physical/mental/oral/cognitive health and its determinants. For each health domain, we examined how self-rating (excellent/very good/good/fair/poor) of health was associated with other domain-relevant indicators (e.g., the number of chronic diseases, symptoms of depression, problems with teeth or gums, or cognitive performance) and sociocultural factors (e.g., socioeconomic status, acculturation, social network, and social cohesion). Geographic variation was also considered. The correlations between self-ratings and domain-relevant indicators in all health domains were significant but moderate. A series of multivariate regression models of self-ratings of physical/mental/oral/cognitive health not only confirmed the effect of the domain-relevant health indicators but also demonstrated a critical contribution of sociocultural determinants. Implications for older immigrants were discussed in terms of place, culture, and context.

Social network types, health, and well-being of older Asian Americans

Objectives: The purposes of this study were to: (1) develop an empirical typology of the social networks in diverse groups of older Asian Americans using both structural and subjective criterion variables; and (2) examine the relationship of the social network types to the measures of the health and well-being (self-rating of health, mental distress, and life satisfaction). Method: The participants included 533 older Asian Americans (Chinese, Asian Indian, Korean, Vietnamese, and other Asians) who participated in the 2015 Asian American Quality of Life Survey in Central Texas. Latent profile analysis (LPA) was conducted using seven social network-related variables. The identified typologies were then regressed on the indicators of health and well-being (poor rating of health, probable mental distress, and dissatisfaction with life). Results: The LPA identified the model with four network types as being most optimal. The groups were named "diverse-integrated" (37.5%), "moderately diverse-integrated" (21.2%), "marginally restricted-noncongregant" (22.1%), and "restricted-congregant" (19.1%). The results suggested that compared to the "diverse-integrated" group, the "marginally restricted-noncongregant type" fared worse than "the restricted-congregant group" in that the former had greater odds of both mental distress and dissatisfaction with life while the latter had higher odds only for dissatisfaction with life. Conclusion: Unlike previous network studies, network types were shaped in the continuum of different social ties and subjective evaluation on strength of social ties. Certain ethnic groups were over-represented in specific network types. Such findings suggest the importance of understanding ethnic group variations in network vulnerabilities when considering interventions.

Cognitive and Functional Status of Persons Newly Enrolled at Dementia-Specific Adult Day Centers and Burden of Their Caregivers

Background and Objectives

Recognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee.

Research Design and Methods

We conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status.

Results

On average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least.

Discussion and Implications

Results suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.

Factors associated with dental service use of older Korean Americans

OBJECTIVES

Based on Andersen's healthcare utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status, education and region), oral health needs (problems with teeth or gums and self-rated oral health) and enabling factors (dental health insurance, length of stay in the United States, acculturation and family network).

METHODS

Using data from surveys with Korean Americans aged 60 or older (N = 2128), a Poisson regression model examined predictors of dental visit in the past 12 months.

FINDINGS

More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the United States, and larger family networks were associated with 1.01-1.35 times higher number of dental visits.

CONCLUSION

The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants' oral health and dental care from the perspectives of culture and family.

Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community-dwelling Korean adults

The purpose of this study was to examine whether loneliness mediates the relationship between social engagement and depressive symptoms and to determine how age moderates the mediation effect. Data for this study came from the survey with community-dwelling adults aged 18 and older in South Korea, from March to April 2017. The total of 1,017 respondents were drawn from three age groups (18-44, 45-64, or 65 and older). The mediating effect of loneliness was tested between each of three social engagement-related variables (family network, friend network, and perceived community support) and depressive symptoms. The results showed age differences in mediation: the effect was most pronounced in the relationship of family network with loneliness for the older group, whereas the size of friend network significantly predicted loneliness for younger adults. Both younger and older groups felt less lonely when they had a higher level of perceived community support; the middle age group remained uninfluenced by the mediation effects. Our findings confirm that loneliness is one of the mechanisms by which social engagement exerts its effect on depressive symptoms. As the Korean society embraces its growing proportions of older adults, the results of the study provide implications for adaptive strategies for changing social engagement need and mental health associated with ageing.

Healthcare Navigation Self-Sufficiency in Older Korean Immigrants

Using data from surveys with Korean Americans aged 60 years or above (n = 2,150), the level of healthcare navigation self-sufficiency was assessed, and its related factors were explored. The overall status of self-sufficiency was low; for example, over half of the sample needed assistance with reading and filling out medical documents, and nearly half needed someone to interpret during medical visits. Diminished self-sufficiency in healthcare navigation was associated with disadvantaged social status (e.g., advanced age, female gender, and low education), early stages of immigration (short length of stay in the U.S. and low English proficiency), and lack of personal health resources (e.g., poor health condition and lack of health insurance). The findings shed light on older immigrants' challenges in the use of health services in a broad sense and help identify areas of patient burden and avenues for interventions.

Mental Health Service Use and Perceived Unmet Needs for Mental Health Care in Asian Americans

Using data from the Asian American Quality of Life (AAQoL, n = 2609) survey, logistic regression models of mental health service use and perceived unmet needs were estimated with background variables, ethnicity, and mental health status. More than 44% of the participants were categorized as having mental distress (Kessler 6 [K6] ≥ 6) and 6.1% as having serious mental illness (SMI, K6 ≥ 13). About 23% had used services (mental health specialist, general doctor, and/or religious leader) for their emotional concerns during the past year, and about 7% reported that there was a time that they needed mental health care but could not get it. In the multivariate analyses, the presence of mental distress and SMI increased the odds of using any service and having perceived unmet needs. Those who had used services exhibited higher odds of reporting unmet needs, calling concerns about the quality of services and user satisfaction.

A Typology of Social Networks and Its Relationship to Psychological Well-Being in Korean Adults

The purposes of this study were to (a) develop an empirical typology of the social networks in Korean adults aged 18 years or older and (b) examine the relation of network types on depressive symptoms and satisfaction with life. Data for this study were drawn from the survey with 1,017 community-dwelling adults aged 18 years or older in South Korea representing three life stages: young adults, middle-aged adults, and older adults. Latent profile analysis was conducted based on eight social network-related variables: marital status, living arrangement, number of family confidants, number of friend confidants, frequency of contact with friends using phone or social media, frequency of participation in social groups, frequency of conversation with neighbors, and perceived closeness of family. The identified typologies were then regressed on depressive symptoms and satisfaction with life. A model with four network types was identified as being the most optimal, and the groups were labeled as: diverse-family, diverse-friend, solo-restricted, and coresident-restricted. Regression analyses showed that in comparison with the coresident-restricted group referent, diverse-friend and solo-restricted groups exhibited elevated levels of depressive symptoms; diverse-family and diverse-friend type had higher levels of satisfaction with life. Implications of the study findings were discussed in line with current research and intervention efforts.

Measurement Equivalence of English Versus Native Language Versions of the Kessler 6 (K6) Scale: An Examination in Three Asian American Groups

The use of languages other than English in population-based surveys is necessitated by the linguistic diversities in the United States. However, inclusion of multiple languages in survey data collection raises concerns about whether an instrument administered in different languages functions equivalently across groups. Using the Kessler Psychological Distress Scale 6 (K6), the present study examined differential item functioning (DIF) between surveys conducted either in English or the native language of the groups of Chinese Americans (n = 622), Korean Americans (n = 471), and Vietnamese Americans (n = 513). DIF analyses using a series of multiple indicator multiple cause (MIMIC) models showed that there were substantial differences between English and non-English versions in the endorsement of the K6 items, with patterns that differed by ethnicity. The K₄ (depressed) showed DIF in all three groups: non-English survey users consistently showed a higher degree of endorsement compared to their English using counterparts. It is speculated that its translated expression in Asian languages may carry less associations with illness/disorder than the English word, thereby making it easy to endorse among Asian language survey users. Findings suggest a lack of measurement equivalence between the K6 administered in English and Asian languages and call for caution in cross-linguistic contexts.

A latent class analysis of social activities and health among community-dwelling older adults in Korea

OBJECTIVES

This study presents an empirical typology of social activity and its association with the depressive symptoms and self-rated health of community-dwelling older adults (n = 464) in South Korea.

METHOD

Latent class analysis (LCA) was used to classify the types of social activities. Data analyses were conducted using Mplus 7.2 program for LCA and SPSS 22.0 for multiple regression analyses.

RESULTS

LCA identified people who fell into one of the four activity groups: Diverse, Community Center/Disengaged, Religion Plus, and Friendship/Leisure. Membership in these four groups predicted differences in depressive symptoms and self-rated health.

CONCLUSIONS

Results indicate that typologies of social activity could enhance practitioners' understanding of activity patterns and their associations with health and well-being.

Associations of a social network typology with physical and mental health risks among older adults in South Korea

OBJECTIVES

The objectives of this study were to (1) develop an empirical typology of social networks in older Koreans; and (2) examine its effect on physical and mental health.

METHOD

A sample of 6900 community-dwelling older adults in South Korea was drawn from the 2014 Korean National Elderly Survey. Latent profile analysis (LPA) was conducted to derive social network types using eight common social network characteristics (marital status, living arrangement, the number and frequency of contact with close family/relatives, the number and frequency of contact with close friends, frequency of participation in social activities, and frequency of having visitors at home). The identified typologies were then regressed on self-rated health and depressive symptoms to explore the health risks posed by the group membership.

RESULTS

The LPA identified a model with five types of social network as being most optimal (BIC = 153,848.34, entropy = .90). The groups were named diverse/family (enriched networks with more engagement with family), diverse/friend (enriched networks with more engagement with friends), friend-focused (high engagement with friends), distant (structurally disengaged), and restricted (structurally engaged but disengaged in family/friends networks). A series of regression analyses showed that membership in the restricted type was associated with more health and mental health risks than all types of social networks except the distant type.

CONCLUSION

Findings demonstrate the importance of family and friends as a source of social network and call attention to not only structural but also non-structural aspects of social isolation. Findings and implications are discussed in cultural contexts.

Asian Americans' concerns and plans about Alzheimer's disease: The role of exposure, literacy and cultural beliefs

Responding to the increase of the Asian American population and the growing imperative to address issues on Alzheimer's disease (AD) in diverse populations, this study examined Asian Americans' concerns about AD (both concerns about one's own development of AD and about becoming an AD caregiver) and plans for AD. Focus was given on exploring the role of AD exposure, AD literacy and cultural beliefs about AD in predicting AD-related concerns and plans. Using data from 2,609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression models of three outcome measures (concerns about one's own development of AD, concerns about becoming an AD caregiver and plans about AD) were estimated. AD exposure and literacy (perceived knowledge and awareness of services) were common predictors of all three outcomes. Beliefs that associate AD with a normal part of ageing and a matter of fate increased the odds of having AD concerns. The odds of having AD plans were found to be higher among those with such concerns. Findings not only identified the factors associated with the concerns and plans about AD but also informed ways to develop targeted AD interventions for Asian Americans.

A computational algorithm for personalized medicine in schizophrenia

Despite advances in sequencing candidate genes and whole genomes, no method has accurately predicted who will or will not benefit from a specific antipsychotic medication among patients with schizophrenia. We propose a computational algorithm that utilizes a person-centered approach that directly identifies individual patients who will respond to a specific antipsychotic medication. The algorithm was applied to the data obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The predictors were either (1) 13 single-nucleotide polymorphisms (SNPs) and 53 baseline variables or (2) 25 SNPs and the same 53 baseline variables, depending on the existing findings and data availability. The outcome variables were either (1) improvement in the Positive and Negative Syndrome Scale (PANSS) (Yes/No) or (2) completion of phase 1/1A (Yes/No). Each of those four predictor-outcome combinations was tried for each of the five antipsychotic medications (Perphenazine, Olanzapine, Quetiapine, Risperidone, and Ziprasidone), leading to 20 prediction experiments. For 18 out of 20 experiments, all three performance measures were greater than 0.50 (sensitivity 0.51-0.79, specificity 0.52-0.79, accuracy 0.52-0.74). Notably, the model provided a promising prediction for Ziprasidone for the case involving completion of phase 1/1A (Yes/No) predicted by 13 SNPs and 53 baseline variables (sensitivity 0.75, specificity 0.74, accuracy 0.74). The proposed algorithm simultaneously used both genetic information and clinical profiles to predict individual patients' response to antipsychotic medications. As the method is not disease-specific but a general algorithm, it can be easily adopted in many other clinical practices for personalized medicine.

The risk typology of healthcare access and its association with unmet healthcare needs in Asian Americans

Using data from the 2015 Asian American Quality of Life Survey (N = 2,609), latent profile analysis was conducted on general (health insurance, usual place for care and income) and immigrant-specific (nativity, length of stay in the U.S., English proficiency and acculturation) risk factors of healthcare access. Latent profile analysis identified a three-cluster model (low-risk, moderate-risk and high-risk groups). Compared with the low-risk group, the odds of having an unmet healthcare need was 1.52 times greater in the moderate-risk group and 2.24 times greater in the high-risk group. Challenging the myth of model minority, the present sample of Asian Americans demonstrates its vulnerability in access to healthcare. Findings also show the heterogeneity in healthcare access risk profiles.

Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression

OBJECTIVES

Despite a high prevalence of mental health problems, racial/ethnic minorities are often reluctant to seek mental health services. Their reluctance may be shaped by cultural beliefs and stigma about mental health. The present study examined how beliefs and stigma about depression (e.g. disbelief in depression as a health-related condition, perception of depression as a normal part of aging, and/or depression as a sign of personal weakness/family shame) pose barriers to older Korean Americans' willingness to use mental health counseling and antidepressants.

METHOD

Data were drawn from surveys with 420 Korean American older adults (M_age= 71.6, SD = 7.6) living in the New York City metropolitan area in 2010. Using a separate logistic regression model, the role of beliefs and stigma about depression in predicting participants' willingness to receive mental health counseling and to take antidepressants was tested. Based on Andersen's behavioral health service use model, the analysis was conducted in consideration of predisposing characteristics (age, gender, marital status, education, and acculturation), mental health needs (anxiety, depressive symptoms, and self-rated mental health), and enabling/hindering factors (beliefs and stigma).

RESULTS

Similar proportions of the sample (69-70%) indicated their willingness to use mental health counseling or antidepressants. Willingness was more likely among participants who had beliefs about depression as a health-related concern (OR = 1.94, 95% CI = 1.15-3.27 for mental health counseling; OR = 4.47, 95% CI = 2.59-7.70 for antidepressants) and less likely among those who associated depression with family shame (OR = .55, 95% CI = 0.33-0.91 for mental health counseling; OR = .56, 95% CI = 0.33-0.95 for antidepressants).

CONCLUSION

In addressing mental health problems and promoting the use of mental health services, cultural beliefs and stigma shared within an ethnic community should be considered. Given that disbelief in the medical model of depression and family shame reduced willingness to use mental health counseling and antidepressants, promoting mental health literacy for older immigrants could be beneficial.

Latent Profiles of Acculturation and Their Implications for Health: A Study With Asian Americans in Central Texas

The present study identified profiles of acculturation in Asian Americans and explored their implications for health. Pointing out the upward selection bias of Asian Americans in English-only surveys, the study calls attention to the importance of obtaining Asian American samples that reflect the group's cultural and linguistic diversities. Data were drawn from 2,602 participants (age range = 18-98) in the 2015 Asian American Quality of Life (AAQoL) Survey, conducted in central Texas. To reach out to diverse groups of Asian Americans, culturally and linguistically sensitive approaches (e.g., survey questionnaire in Asian languages, bilingual/bicultural recruiters and survey assistants, and partnerships with key individuals and organizations within ethnic communities) were employed, resulting in a sample almost half of which were surveyed in their native languages. Latent profile analysis based on acculturation-related variables (nativity, proportion of life lived in the United States, English speaking ability, familiarity with host culture, familiarity with heritage culture, identity toward ethnic origin, and sense of belonging to the community of ethnic origin) identified a 4-cluster solution: fully bicultural, moderately bicultural, alienated from host culture, and alienated from heritage culture. The fully bicultural group was most advantaged in terms of self-ratings of physical, oral, and mental health. The alienated from heritage culture group demonstrated a particular risk for physical and mental health, whereas the alienated from host culture group was at risk for oral health. Findings not only help understand the heterogeneity of acculturation in Asian Americans but also provide implications for health interventions.

Oral Health and Dental Care in Older Asian Americans in Central Texas

OBJECTIVES

To examine factors associated with dental health insurance, self-rated oral health, and use of preventive dental care services in older Asian Americans.

DESIGN

Cross-sectional survey.

SETTING

The Asian American Quality of Life Survey was conducted with 2,614 Asian Americans living in central Texas using questionnaires available in English and six Asian languages.

PARTICIPANTS

Asian American Quality of Life Survey participants aged 60 and older (N = 533; mean age = 69.4 ± 6.9).

MEASUREMENTS

Participants were asked whether they had insurance that covered the cost of any dental visit, how they would rate their overall oral health status, and whether they had visited a dental clinic for a routine examination in the past 12 months. Information was also collected on sociodemographic and immigration-related variables.

RESULTS

More than 61% of the sample had no dental health insurance, 45% reported that their oral health was fair or poor, and 44% had not used preventive dental care services. A series of logistic regression analyses identified factors posing a significant risk to oral health and dental care. For example, those with limited English proficiency were 3.5 times as likely to lack dental health insurance and 3.2 times as likely to rate their oral health as fair or poor. The odds of not using preventive dental care services were 6.4 times as great in those without dental health insurance.

CONCLUSION

The overall findings call attention to efforts to promote oral health and dental care in older Asian Americans.

The relation between living alone and depressive symptoms in older Korean Americans: do feelings of loneliness mediate?

OBJECTIVES

As the opposite end of the continuum from social integration, social isolation may put individuals at a greater risk of poor mental health. Conceptualizing living alone as an objective and structural indicator of social isolation and loneliness as subjective perceptions of social isolation, the present study hypothesized that the relation between living alone and depressive symptoms would be mediated by the feelings of loneliness. Using older Korean Americans as the target population, the mediation model was examined in consideration of the contextual factors such as demographics (age, gender, education, perceived income, and length of stay in the USA), health (chronic conditions and functional disability), and general social integration (size of social network and community social cohesion).

METHOD

Date were drawn from surveys with 209 older Korean Americans in Central Texas (M_age = 69.6, SD = 7.5). Multivariate regression models of depressive symptoms were entered in the following order: (1) demographics, (2) health, (3) living alone, (4) social network/community social cohesion, and (5) loneliness. The mediation effect of loneliness in the relationship between living alone and depressive symptoms was separately examined using the bootstrapping method.

RESULTS

Loneliness was found to mediate the relation between living alone and depressive symptoms (indirect effect = 1.03, 95% CI = .05-2.08).

CONCLUSION

The results suggest that subjective perceptions of loneliness may explain the mechanism through which objective social isolation presents risks for depressive symptoms in older Korean Americans.

Mental health literacy in religious leaders: a qualitative study of Korean American Clergy

Although religious leaders in ethnic minority communities are often the first point of contact for mental health needs, little is known about their mental health literacy. The aim of the current study was to explore the knowledge and beliefs about depression held by Korean American clergy, using a qualitative approach. The Gateway Provider Model (GPM) and Jorm's conceptualisation of mental health literacy served as a framework for the enquiry. Seventeen clergy members serving in Korean communities in two U.S. metropolitan cities participated in an individual in-depth interview during the spring of 2013. Using the constant comparison method, the research team coded the data independently, compared and modified codes, and derived major categories and themes in consensus approach. Eight themes emerged from the interviews, and they were grouped into five categories: (i) the ability to identify the problem; (ii) knowledge about causes and risk factors; (iii) knowledge and beliefs about treatment; (iv) knowledge about resources and services; and (v) contextual factors. Despite some variations, a majority of the participants acknowledged that depression is an important issue in the Korean American community and felt a sense of responsibility for the well-being of their community members. The findings highlight the need for mental health education and training for religious leaders in ethnic minority communities to help them properly respond to community mental health needs.

The Knowing–Doing Gap in Advance Directives in Asian Americans: The Role of Education and Acculturation

Objectives:

The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs.

Methods:

Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects.

Results:

The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education.

Conclusions:

The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.

Some Thoughts on the Measurement of Acculturation among Mexican American Elders

This article examines a subset of acculturation items pertaining to language fluency and use and to interpersonal relationships. This study included 3,050 Mexican American elders aged 65 to 99, randomly sampled from five states in the southwestern United States. A standard acculturation inventory was used as the source for two factor-derived scales that dealt with language and social acculturation. In addition, three other measures were derived on the basis of the acculturation inventory: language and social biculturality scores were created by simple counts of the number of “in-between” scores on the inventory, and an index of neighborhood acculturation was created by computing the average score on the language acculturation factor for each of the 209 primary sampling units used in the sampling frame. The acculturation scales demonstrated reasonable levels of reliability and concurrent validity. Results suggest that multiple approaches to measuring acculturation can be created from existing measures.

Acculturation and Its Effect on Depressive Symptom Structure in a Sample of Mexican American Elders

In this study, we compared the depressive symptoms reported by Mexican American elders who scored higher and lower on a linguistic acculturation scale. Prevalence, equality of covariance matrices, equality of error variances, and factor structures were examined for the 20 items included in the Center for Epidemiologic Studies Depression (CES-D) Scale. The sample consisted of 3,050 community-dwelling Mexican Americans from five states. Significant differences were found on all parameters, indicating that level of acculturation is associated with pervasive differences in the way items are endorsed on the most commonly used inventory of depressive symptoms. Results add to literature suggesting that there may not be a universal structure to symptoms. Higher or lower scores may have different implications for people representing different cultures and/or stages of acculturation, something that both researchers and clinicians should be sensitive to when interpreting results of screening tests.

Correlates of Sense of Control among Older Korean-American Immigrants: Financial Status, Physical Health Constraints, and Environmental Challenges

Responding to the need for more research on minority older populations, the present study assessed sense of control among older Korean-American immigrants. The association of sense of control with financial status, physical health constraints, and environmental challenges was examined with a sample of 230 older Korean-Americans (Mage = 69.8, range = 60–92) in Florida. In a hierarchical regression analysis, financial limitations (poorer perceived financial status and receipt of financial support from adult children), physical health constraints (greater functional disability), and environmental challenges (lower acculturation and greater difficulty with transportation) were identified as significant risk factors for a diminished sense of control. Findings are discussed in a cultural context, and ways to promote sense of control among immigrant older populations are suggested.

Health Vulnerability of Immigrants with Limited English Proficiency: A Study of Older Korean Americans

OBJECTIVES

To examine the extent to which limited English proficiency (LEP) poses a risk to physical and mental health, using older Korean Americans as a target population.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Older Korean Americans (N = 1,301).

MEASUREMENTS

Health outcomes were indexed using binary variables covering activity limitation, self-rated health, and probable depression. Participants who reported that they spoke English less than very well were categorized as manifesting LEP.

RESULTS

Approximately 71% of the sample had LEP. Those with LEP scored lower on all measures of health than their English-proficient counterparts. In multivariate models, the risk of having activity limitations was 2.72 times as great (95% confidence interval (CI) = 1.72-4.29, P < .001), a fair or poor rating of health 2.59 times as great (95% CI = 1.91-3.49, P < .001), and probable depression 1.73 times as great (95% CI = 1.29-2.31, P < .001) in participants with LEP.

CONCLUSION

Limited English proficiency was identified as a critical source of health vulnerability. Systematic efforts should be made to reach out to older immigrants with LEP and include them in health-related research and prevention and intervention programs.