Perceived neighborhood environment affecting physical and mental health: a study with Korean American older adults in New York City

This study examined how subjective perceptions of the neighborhood environment (e.g., perceived ethnic density, safety, social cohesion, and satisfaction) influenced the physical and mental health of Korean American older adults. Using data from 420 residents of the New York City metropolitan area (M(age) = 71.6, SD = 7.59), health perceptions and depressive symptoms were estimated with hierarchical regression models entered in the order of (1) demographics and acculturation, (2) health-related variables, and (3) perceived neighborhood environment. After controlling for the effects of the individual-level variables, perceived neighborhood environment was found to make a significant contribution to both outcomes. Individuals less satisfied with their overall neighborhood environment were more likely to have negative perceptions of health and depressive symptoms. A strong linkage between perceived neighborhood safety and depressive symptoms was also observed. Findings from the study highlight the importance of subjective evaluations of neighborhood environment and provide implications for health promotion.

Overweight and its association with aortic pressure wave reflection after exercise

BACKGROUND

Obesity is associated with arterial stiffening, left ventricular (LV) hypertrophy, and diastolic dysfunction. However, there is no data regarding dynamic changes in arterial hemodynamics with exercise in overweight subjects. We hypothesized that overweight women would show a different exercise response in wave reflection compared with lean women.

METHODS

A total of 59 overweight and 68 lean nondiabetic women (mean age 63 ± 7 years) underwent symptom-limited supine bicycle exercise testing with simultaneous two-dimensional and Doppler echocardiography. Central hemodynamics including central aortic pressure and augmentation index (AIx) were obtained at rest and immediately after peak exercise using radial artery tonometry.

RESULTS

Overweight women showed a higher LV mass index (lean vs. overweight; 40.2 ± 10.2 vs. 45.3 ± 11.0 g/m(2.7), P = 0.007) and a lower early diastolic mitral annular velocity (6.3 ± 1.8 vs. 5.5 ± 1.6 cm/s, P = 0.013) than lean women. Although the two groups did not differ in peripheral and central hemodynamics including AIx (36.3 ± 11.7 vs. 36.8 ± 10.2%, P = 0.830) and AIx normalized for heart rate 75/min (AIx@75, 30.4 ± 11.5 vs. 30.1 ± 9.9%, P = 0.885) at rest, AIx (20.9 ± 11.5 vs. 27.6 ± 10.4%, P = 0.004) and AIx@75 (25.8 ± 10.2 vs. 31.6 ± 7.7%, P = 0.002) at peak exercise were significantly higher in overweight women. In simple correlation analysis, body mass index (BMI) showed significant correlations with AIx, and AIx@75 at peak exercise, whereas no relationships were found with those parameters at rest. Multiple regression analysis showed that BMI was an independent determinant of AIx@75 at peak exercise (β = 0.28, P = 0.004).

CONCLUSIONS

Despite similar resting peripheral and central hemodynamics, the wave reflection in overweight women after exercise differed from that in lean women. These findings suggest that being overweight is related to higher wave reflection after exercise.

Neighborhood Effects on Physical and Mental Health: A Study of Korean American Older Adults

This study explored how the physical and mental health of Korean American older adults were influenced by neighborhood characteristics (i.e., proportion of individuals living below the poverty level, proportion of individuals 65 years of age and older, and proportion of racial/ethnic minorities in the census block groups where each respondent lived). Health perceptions (i.e., the subjective appraisal of one's own health) and depressive symptoms were used as indicators of physical and mental health. Multilevel analyses were performed with 567 individuals (at Level 1) nested within 233 census block groups (at Level 2). After controlling for individual demographic and health characteristics, we found that neighborhood poverty predicted health perceptions. The results add to the growing literature on the influence of the social environment and suggest that neighborhood characteristics should be taken into consideration in developing community-based policies for racially/ethnically diverse populations.

Associations between self-rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist?

OBJECTIVE

[corrected] This study examined racial/ethnic differences in the association between self-rated mental health (SRMH) and psychiatric disorders among community-dwelling older adults in the United States.

DESIGN

Cross-sectional analyses of nationally representative data from the Collaborative Psychiatric Epidemiology Surveys (2001-2003).

SETTING

In-person household interviews.

PARTICIPANTS

Older adults aged 60 and older (N = 1,840), including non-Hispanic Whites (N = 351), Blacks (N = 826), Hispanics (N = 406), and Asians (N = 257).

MEASUREMENTS

SRMH was measured with a single item, "How would you rate your own mental health?" Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnoses for mood and anxiety disorders were measured with the World Health Organization's World Mental Health version of the Composite International Diagnostic Interview.

RESULTS

Results from logistic regression analyses showed significant main effects of both SRMH and race/ethnicity on the presence of mood and anxiety disorders: people who have poor SRMH and are non-Hispanic Whites were more likely to have mood and anxiety disorders. There were also significant interaction effects between SRMH and race/ethnicity, such that the relation of SRMH with diagnoses of psychiatric disorders was strongest in non-Hispanic Whites.

CONCLUSIONS

Racial/ethnic variations were found in the relationship between self-perception of mental health and DSM-IV psychiatric disorders. The findings suggest the need to develop race/ethnicity-specific strategies to screen psychiatric disorders in diverse elderly populations. Future studies are needed to investigate possible reasons for the racial/ethnic group differences.

Attitudes toward mental health services in Hispanic older adults: the role of misconceptions and personal beliefs

Focusing on misconceptions and personal beliefs associated with depression, the present study explored predictors of attitudes toward mental health services in a sample of 297 Hispanic older adults living in public housing (M age = 76.0 years, SD = 7.74). Results from a hierarchical regression analysis showed that negative attitudes towards mental health services were predicted by advanced age, belief that having depression would make family members disappointed, and belief that counseling brings too many bad feelings such as anger and sadness. Findings suggest that interventions designed to promote positive attitudes toward mental health services of older Hispanics should address misconceptions and personal beliefs.

The interactive role of chronic medical conditions and sleep disturbance in predicting depressive symptoms among Korean American older adults

OBJECTIVES

This study examined the independent and interactive effects of chronic medical conditions and sleep disturbance on depressive symptomatology. The sample (N = 675) consisted of community-dwelling Korean American older adults, a group that has been found to be particularly high in depressive symptomatology.

METHODS

A hierarchical regression model of depressive symptoms was estimated with an array of predictors: (a) demographic variables, including immigration history, (b) chronic medical conditions, (c) sleep disturbance, and (d) an interaction between chronic medical conditions and sleep disturbance.

RESULTS

After controlling for the effects of demographic variables, both chronic medical conditions and sleep disturbance were identified as independent risk factors for depressive symptoms. Moreover, their interaction was significant, indicating that the coexistence of chronic medical conditions and sleep disturbance was significantly associated with higher levels of depressive symptoms (β = 0.15, p < 0.01).

CONCLUSION

Our findings call attention to sleep hygiene among older individuals with chronic medical conditions and recommend that sleep quality should be closely monitored and assessed by healthcare professionals.

Social activity and depressive symptoms in Korean American older adults: the conditioning role of acculturation

OBJECTIVE

This study examined the independent and interactive effects of acculturation and social activity on depressive symptoms.

METHOD

Using a sample of community-dwelling Korean American older adults (N = 675), hierarchical regression models of depressive symptoms were estimated with an array of predictors: (a) demographic variables, (b) health-related variables, (c) acculturation, (d) social activity, and (e) an interaction between acculturation and social activity.

RESULTS

After controlling for the effects of demographic and health-related variables, both acculturation and social activity were identified as significant predictors. Moreover, their interaction was significant (β = .09, p < .05). Further analysis showed that the beneficial effect of social activity on mental health was particularly strong among those with lower levels of acculturation.

DISCUSSION

Our findings suggest that enhancing opportunities for social engagement may serve to protect and promote the mental health of vulnerable older immigrants, particularly those who are less acculturated.

Limited English proficiency as a barrier to mental health service use: a study of Latino and Asian immigrants with psychiatric disorders

Language barriers pose problems in mental health care for foreign-born individuals in the United States. Immigrants with psychiatric disorders may be at particular risk but are currently understudied. The purpose of this study was to examine the effect of limited English proficiency (LEP) on mental health service use among immigrant adults with psychiatric disorders. Drawn from the National Latino and Asian American Study (NLAAS), Latino and Asian immigrant adults aged 18-86 with any instrument-determined mood, anxiety, and substance use disorder (n = 372) were included in the present analysis. Results from hierarchical logistic regression analyses showed that having health insurance, poor self-rated mental health, and more psychiatric disorders were independently associated with higher probability of mental health service use in the Latino group. After controlling for all background characteristics and mental health need factors, LEP significantly decreased odds of mental health service use among Latino immigrants. None of the factors including LEP predicted mental health service use among Asian immigrants, who were also the least likely to access such services. LEP was a barrier to mental health service use among Latino immigrants with psychiatric disorders. This study suggests that future approaches to interventions might be well advised to include not only enhancing the availability of bilingual service providers and interpretation services but also increasing awareness of such options for at least Latino immigrants. In addition, further investigation is needed to identify factors that can enhance access to mental health care services among Asians.

Gender differences in depressive symptoms among older Korean American immigrants

Despite consistent reports over many years of a greater prevalence of depression among women, mechanisms underlying the gender difference remain unclear. Mechanisms relevant to immigrant elderly populations are virtually unexplored. The present study examined gender variations in depressive symptoms using a community sample of 230 older Korean American immigrants (M(age) = 69.8; standard deviation = 7.05) in Florida. We were interested in examining not only mean differences but gender differences in the impact of demographic variables (age, marital status, and education), health constraints (chronic conditions and functional disability), and personal resources (sense of control, social network, and acculturation) on depressive symptoms. Consistent with previous literature, women scored higher on depressive symptoms than men. In a hierarchical regression model, women and those with more chronic conditions, greater functional disability, and lower sense of control were found to have more depressive symptoms. The interaction of gender-by-chronic conditions was found to be significant, and further analysis indicated that the association of chronic conditions with mental well-being was stronger for women. The findings suggest that among older Korean immigrants, women are at particular risk of declining psychological well-being in the face of physical health problems and call attention to the need for interventions designed to promote their physical and mental health.

Willingness to Use Mental Health Services Among Older Residents in Assisted Living

Examining the importance of mental health care in assisted living (AL) settings, the present study examines older AL residents’ willingness to use mental health services and its predictors. Data based on face-to-face interviews with 150 older residents from 17 AL settings in Florida are used in the analyses ( Mage = 82.8, SD = 9.4). Multivariate logistic regression is used to estimate the likelihood of willingness to use mental health services in relation to predisposing (demographics and physical health), mental health needs (depressive symptoms), and enabling variables (social network, instrumental support, emotional support, informational support, satisfaction with support, and previous use of mental health services). Willingness to use mental health services is predicted by younger age, unmarried status, lower levels of emotional support, and higher levels of informational support. The relationship of informational support to higher willingness to use mental health services suggests that AL residents could benefit from educational interventions on late life depression.

Not saying I am happy does not mean I am not: cultural influences on responses to positive affect items in the CES-D

OBJECTIVES

Given the emphasis on modesty and self-effacement in Asian societies, the present study explored differential item responses for 2 positive affect items (5 = Hopeful and 8 = Happy) on a short form of the Center for Epidemiologic Studies-Depression scale. The samples consisted of elderly non-Hispanic Whites (n = 450), Korean Americans (n = 519), and Koreans (n = 2,030).

METHOD

Multiple Indicator Multiple Cause models were estimated to identify the impact of group membership on responses to the positive affect items while controlling for the latent trait of depressive symptoms.

RESULTS

The data revealed that Koreans and Korean Americans were less likely than non-Hispanic Whites to endorse the positive affect items. Compared with Korean Americans who were more acculturated to mainstream American culture, those who were less acculturated were less likely to endorse the positive affect items.

DISCUSSION

Our findings support the notion that the way in which people endorse depressive symptoms is substantially influenced by cultural orientation. These findings call into question the common use of simple mean comparisons and a universal cutoff point across diverse cultural groups.

Health status of older Asian Americans in California

Given the paucity of research on differences between older adults representing the many Asian-American subcategories, the present study explored physical and mental health status in five subcategories of Asian Americans aged 60 and older: Chinese, Japanese, Korean, Vietnamese, and Filipino. Data were drawn from the 2007 California Health Interview Survey (CHIS). Background characteristics and physical and mental health conditions were compared, with results showing differences cross the five subcategories of older Asian Americans. Specific patterns were identified in chronic diseases, disease comorbidity, and disability rates. Vietnamese and Filipinos tended to have poorer physical health than Chinese, Japanese, and Koreans. The poorest self-rated health and the highest disability rate were found in the older Vietnamese. Filipinos also exhibited the greatest number of chronic diseases, including the highest rates of asthma, high blood pressure, and heart disease. Although Koreans had the fewest self-reported chronic diseases and the least evidence of disease comorbidity, they also had the highest psychological distress. The lowest psychological distress was found in older Japanese. Findings suggest that generalizing findings from one particular Asian category or from an aggregate Asian category may be problematic and may not reflect an accurate picture of the burden of health in specific Asian categories. Being aware of these differences in background and health characteristics may help providers to better serve older Asian clients.

Knowledge of Depression Among Korean American Older Adults

The present study explored knowledge about depression and the factors that predict that knowledge in a sample of Korean American older adults (N = 675). Compared with other published results, knowledge of depression in the present sample was generally low. The participants provided on average only 42.6% correct answers on the 12-item Depression in Late Life Quiz, and for 9 items, more than 50% of the participants provided incorrect answers. In a multivariate linear regression, acculturation (β = .12, p < .01) and depressive symptoms (β = -.09, p < .05) were significant predictors of knowledge. Individuals with lower levels of acculturation had less knowledge of depression. An interesting finding was that those with higher levels of depressive symptoms exhibited poorer knowledge of depression. The study findings emphasized the need for educational interventions to be provided in order to improve the mental health literacy of Korean American older adults.

Perceived Discrimination in Older Korean Americans

This study explored a potential pathway by which perceived discrimination may affect levels of depressive symptoms in a sample of 472 Korean American older adults (M (age)= 69.9, SD = 7.04). Building upon previous studies demonstrating that perceived discrimination has negative impacts on mental health, we hypothesized that sense of control would mediate the associations between perceived discrimination and depressive symptoms. Our analyses showed that the effects of perceived discrimination on depressive symptoms were not only direct but also mediated through a lowered sense of control. Finding that sense of control serves as an intervening step between perceived discrimination and mental health may help explicate the psychological mechanisms involved in responses to discriminatory experience and has implications for intervention strategies.

Willingness of older Korean-American adults to use hospice

Responding to an urgent need for more research on end-of-life concerns of racial and ethnic minorities, the present study explored predictors of willingness of older Korean-American adults (N=675) to use hospice. Guided by Andersen's behavioral health model, the study considered predisposing factors (age, sex, marital status, education), potential health needs (chronic conditions, functional disability), and enabling factors (health insurance, acculturation, prior awareness of hospice). Nearly three-quarters of the sample answered yes to the following statement and question, "Hospice is a program that helps people who are dying by making them feel comfortable and free of pain when they can no longer be cured of their disease. If you needed hospice services, would you use them?" A greater willingness was observed in younger persons (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) and those with higher levels of education (OR=1.67, 95% CI=1.12-2.48), more chronic conditions (OR=1.23, 95% CI=1.05-1.44), health insurance (OR=0.59, 95% CI=0.37-0.94), higher levels of acculturation (OR=1.07, 95% CI=1.03-1.10), and prior awareness of hospice (OR=4.43, 95% CI=2.85-6.90). The present study highlights the role of prior awareness in shaping individuals' attitudes toward services, calling attention to a need for community education and outreach programs for racial and ethnic minorities, with specific emphasis on dissemination of information and greater awareness of hospice services.

Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents

OBJECTIVE

To evaluate the vascular response at 9 months after zotarolimus-eluting stent (ZES; Endeavor) implantation using optical coherence tomography (OCT). These findings were compared with those after implantation of a sirolimus-eluting stent (SES; Cypher Select).

DESIGN

Cross-sectional observational study with prospective OCT registry.

SETTING

Nine months after ZES or SES implantation.

PATIENTS AND METHODS

A total of 68 patients (32 ZES and 36 SES) underwent OCT at 9 months after stent implantation. The neointima hyperplasia (NIH) thickness inside each strut and percentage of NIH area at every 1 mm cross section were measured.

MAIN OUTCOME MEASUREMENT

The degree of neointimal coverage and the prevalence of malapposition at 9 months after ZES and SES implantation using OCT.

RESULTS

The mean (SD) NIH thickness (251.2 (110.0) mum vs 85.5 (53.3) mum, p<0.001) and percentage of NIH area (27.9 (9.1)% vs 11.2 (7.1)%, p<0.001) were significantly greater in ZES than in SES. The prevalence of uncovered strut as well as malapposed strut was significantly lower in ZES than in SES (0.3% vs 12.3%, p<0.001 and 0.08% vs 2.6%, p<0.001). Thrombus was not observed in ZES (0.0% in ZES vs 27.8% in SES, p = 0.001).

CONCLUSIONS

Neointimal coverage in ZES was almost complete and malapposition was very rare at 9-months' follow-up.

Living in a different world: acculturative stress among Korean American elders

Using a sample of Korean American elders, this study examined internal mechanisms by which the level of acculturation influences mental health outcomes. We hypothesized that the impact of five domains of acculturation on mental distress (depressive symptoms and anxiety) would be mediated by individuals' subjectively appraised acculturative stress. The latter was indexed by measures of task-oriented and emotion-oriented stress. The results from structural equation modeling with 472 Korean American elders in Florida (M age = 69.9, SD = 7.04) provided support for the mediation model. Findings demonstrate that acculturation exerts an influence on mental health and that acculturative stress functions as a mediator in the linkage between the level of acculturation and mental distress. Findings suggest avenues for facilitating immigrant elders' positive adaptation and promoting their mental well-being.

Self-rating of poor health: a comparison of Cuban elders in Havana and Miami

This study examined the prevalence of self-reported 'poor health' among Cuban elders in Havana (n = 1,183) and Miami (n = 288) and explored the roles of chronic conditions and functional disability in their self-reports. A logistic regression model of reported poor health was estimated for each group, testing both independent and interactive effects of chronic conditions and functional disability. Despite differences in sociodemographic characteristics and disease/disability profiles between Cuban elders in the two cities, an equal proportion of each group (13%) reported poor health. Financial strain and functional disability were common predictors of self-reported poor health across the groups. Gender and chronic conditions were significant only in the Havana sample, among whom the likelihood of reporting poor health increased with female gender and the presence of chronic conditions. In the Havana sample, not only did chronic conditions have an independent effect, but also its interaction with functional disability was significant. The overall results suggest a particular role of chronic conditions in determining subjective health among elders in Havana. Findings are discussed in a sociocultural context.