Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach

Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone

Background

Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior.

Methods

This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data.

Results

The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions.

Conclusion

This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11923-1.

Dementia and Cognitive Decline in Older Adulthood: Are Agricultural Workers at Greater Risk?

OBJECTIVES

To examine whether long-term exposure to agricultural work is associated with dementia prevalence and the rate of cognitive change in older adulthood.

METHOD

We employed data from the Health and Retirement Study (1998-2014). Multiple logistic regression was used to determine whether a longest-held job in the agricultural sector was associated with differences in dementia prevalence. We examined if hearing impairment, depression, and physical health indicators mediated the relationship between agricultural work and cognitive functioning. Subgroup analyses were done by age, retirement status, job tenure, and cognitive domain. We employed growth curve models to investigate implications of agricultural work on age trajectories of cognitive functioning.

RESULTS

Longest-held job in agriculture, fishing, and forestry (AFF) was associated with 46% greater odds of having dementia. The relationship between AFF exposure and cognitive functioning was not mediated by hearing impairment, depression, or physical health indicators. Results were stronger among younger and retired older adults as well as those with extensive job tenure. AFF exposure was associated with lower scores in working memory and attention and processing speed. Growth curve models indicated that while agricultural work exposure was associated with lower initial levels of cognitive functioning, over time, the pattern reversed with individuals in non-AFF jobs, showing more accelerated cognitive decline.

DISCUSSION

Consistent with European studies, results from the United States also demonstrate a higher prevalence of dementia among agricultural workers. The cognitive reserve framework may explain the seemingly paradoxical result on age patterning of cognitive performance across older adults with different work histories.

Structural Intersectionality as a New Direction for Health Disparities Research

This article advances the field by integrating insights from intersectionality perspectives with the emerging literatures on structural racism and structural sexism-which point to promising new ways to measure systems of inequality at a macro level-to introduce a structural intersectionality approach to population health. We demonstrate an application of structural intersectionality using administrative data representing macrolevel structural racism, structural sexism, and income inequality in U.S. states linked to individual data from the Behavioral Risk Factor Surveillance System to estimate multilevel models (N = 420,644 individuals nested in 76 state-years) investigating how intersecting dimensions of structural oppression shape health. Analyses show that these structural inequalities: (1) vary considerably across U.S. states, (2) intersect in numerous ways but do not strongly or positively covary, (3) individually and jointly shape health, and (4) are most consistently associated with poor health for black women. We conclude by outlining an agenda for future research on structural intersectionality and health.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Aging into disadvantage: Disability crossover among Mexican immigrants in America

The "Hispanic paradox" refers to the accepted finding that Mexican immigrants have lower mortality compared to the US-born population, despite having lower levels of income, educational attainment, and health insurance coverage. However, Mexican immigrants' mortality advantage is not matched by lower disability rates, particularly later in the life course. Past studies have identified a crossover in disability rates for Mexican immigrants using age-specific disability rates but confound the effects of aging and duration of residence. By using the synthetic cohort method, I extend prior work on the disability crossover by tracing immigrant cohorts across the life course and disentangling newly arrived immigrants from those already established in the U.S. I use American Community Survey (ACS) 2015-2019 data to test whether the acculturation or cumulative disadvantage hypotheses account for the disability crossover. I find that, contrary to the expected finding of a socioeconomic health gradient in disability rates, Mexican immigrants' high disability rates converge regardless of education level or immigrant cohort. In addition, Mexican female immigrants are doubly disadvantaged, living in a protracted period of disability compared to males of the same education level. My findings support the negative health acculturation hypothesis as the dominant pathway for Mexican immigrants' later-life disability trajectories and consequently the explanation behind the disability crossover.

Lifetime socioeconomic determinants of health trajectories among older adults

Drawing on life course theory and research, we explored how socioeconomic circumstances during childhood and adulthood shape self-reported health trajectories among older Mexican adults. We used data from the Mexican Health and Aging Study panel survey (2001-2015) and used sequence analysis to estimate types of self-reported health trajectories in older adulthood. We then explored the association between those health trajectories and socioeconomic determinants at different life stages, including education, occupation, employment, economic status, parental education, and adverse living conditions and illnesses during childhood. Our contributions are threefold. First, we identified four types of health trajectories for men and eight for women, representing a more nuanced longitudinal health status profile than previously shown. Second, we found that childhood and adult socioeconomic circumstances influence self-reported health trajectories at older age. Third, our results suggest there is no simple monotonic relationship between life course circumstances and self-reported health trajectories.

Social status differences in allostatic load among young adults in the United States

Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994-1995) and IV (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents' values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24-34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.

Racial Differences in Generalized Anxiety Disorder During the COVID-19 Pandemic among Brazilian University Students: a National Survey

There is evidence that during the COVID-19 pandemic, there was an increase in anxiety and depression rates among college students. However, little is known about how generalized anxiety disorder (GAD) developed among individuals of different race/skin color. This study aimed to determine whether there are racial differences in GAD in Brazilian university students during the COVID-19 pandemic. This is a nationwide cross-sectional study, carried out through the application of online questionnaires to university students from 94 Brazilian universities. Self-reported data on age, sex, economic class, race/skin color, anthropometric data, and adherence to social distancing measures were collected. To determine the GAD, the Generalized Anxiety Disorder 7-item scale was applied. A total of 5879 participants were included, with a mean age of 24.1 ± 6.4 years, and the majority were female (n = 4324, 73.5%), most self-declared to be whites (n = 2945, 50.1%), followed by browns (n = 2185, 37.2%) and blacks (n = 749, 12.7%). The prevalence of GAD among black Brazilian university students (47.3% [95% CI 43.7, 50.8]) was significantly higher than that of browns (38.6% [95% CI 36.6, 40.7]) and whites (44.1% [95% CI 42.3, 45.9]), even after multivariable adjustment by other sociodemographic factors. The findings of the present study suggest a possible racial difference in GAD among Brazilian university students, in which those who declared their race/skin color as black showed a greater risk for GAD than those who declared themselves as white or brown.

Differences in Caregiving Intensity Among Distinct Sociodemographic Subgroups of Informal Caregivers: Joint Effects of Race/Ethnicity, Gender, and Employment

More than 40 million informal caregivers in the United States provide essential care to older adults. Recent research has identified substantial differences in caregiving intensity by gender, race/ethnicity, and employment status. Using intersectionality theory, the current study extends the existing literature by exploring the relationship between caregiving intensity and the unique experiences of individuals with different intersections of gender, ethnicity, and employment. We used generalized linear models to estimate multivariate associations between caregiving intensity assessed by three different measures (hours of caregiving per month and number of activities of daily living and instrumental activities of daily living [IADLs] assisted with) and the three sociodemographic factors of interest (race/ethnicity, gender, and employment status). Unemployed White males provided, on average, 77 fewer hours per month of care (p < 0.001) and assisted with 1.9 fewer IADLs (p = 0.004) than unemployed Black males. Employed White females provided 42.6 fewer hours per month of care (p = 0.002) than employed Black females and 49.2 fewer hours per month (p = 0.036) than employed females of other races. Study findings suggest that examining racial/ethnic or gender differences in isolation does not provide a true picture of differences in caregiving intensity. There is a critical need to understand how the intersections of race/ethnicity, gender, employment, and other sociodemographic factors shape the experiences of caregiver subgroups. [Journal of Gerontological Nursing, 47(7), 23-32.].

The Landscape of Perception: Racial Differences in How Disability Is Viewed Among Older-Adult Cancer Survivors

This paper compares disability perceptions of Black with white older cancer survivors' to document racial disparities in these perceptions and the factors that contribute to them. The data are from a randomly selected tumor registry sample of 321 older adult cancer survivors from an NCI funded study. OLS regression models of disability perceptions, nested by race, examined the effects cancer and non-cancer health factors along with important covariates. Black older adult cancer survivors perceived themselves to be more disabled than did white survivors. Multivariate analyses showed a strong relationship between functional difficulties and disability perceptions for both Black and white survivors. However cancer-related factors such as continuing symptoms of the illness or treatment were relatively more important for Blacks. The findings suggest that race and cancer are both important factors in our understanding of disability in later life. These findings can then inform clinical best practices among minority older adults.

Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies

RATIONALE

Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens.

METHODS

We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion.

RESULTS

Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages.

CONCLUSION

If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.

Assessing the Longitudinal Change in Low Vision: A Test of Competing Hypotheses

Introduction:

Visual impairment among older adults has increasingly become one of the biggest challenges to public health and personal well-being in the United States. This study aims to examine whether the intersectionality hypothesis can be used in conjunction with the cumulative advantage (disadvantage), persistent inequality, or age-as-leveler to explain heterogeneity in low vision trajectories across birth cohorts, race or ethnicity, gender, and the level of education.

Methods:

Growth curve modeling was used to analyze data from the 2002–2014 Health and Retirement Study.

Results:

The type of trajectory (i.e., cumulative advantage or disadvantage, the persistent inequality, and the age-as-leveler) that characterize low vision is largely dependent upon the characteristics of an individual (i.e., race or ethnicity, gender, and education).

Discussion:

Trajectories of low vision are higher among females and those from ethnic minority groups with low levels of education.

Implications for practitioners:

Targeted interventions and attempts to close interethnic disparities in vision functioning should begin early on in life and should focus on racial ethnic minorities, females, and those with low education.

Care Life Expectancy: Gender and Unpaid Work in the Context of Population Aging

Amid growing concern regarding the potential added burden of care due to population aging, we have very little understanding of what is the burden of care in aging populations. To answer this question, we introduce a novel metric that encompasses demographic complexity and social context to summarize unpaid family care work provided to children, elderly, and other family members across the life cycle at a population level. The measure (Care Life Expectancy), an application of the Sullivan method, estimates the number of years and proportion of adult life that people spend in an unpaid caregiving role. We demonstrate the value of the metric by using it to describe gender differences in unpaid care work in 23 European aging countries. We find that at age 15, women and men are expected to be in an unpaid caregiving role for over half of their remaining life. For women in most of the countries, over half of those years will involve high-level caregiving for a family member. We also find that men lag in caregiving across most countries, even when using the lowest threshold of caregiving. As we show here, demographic techniques can be used to enhance our understanding of the gendered implications of population aging, particularly as they relate to policy research and public debate.

Disability and sex/gender intersections in unmet workplace support needs: Findings from a large Canadian survey of workers

INTRODUCTION

Individual attributes including disability and sex/gender have the potential to intersect and determine the likelihood of unmet workplace support needs. Our study compares unmet workplace support needs between workers with and without a disability, and according to disability type and sex/gender differences.

METHODS

Workers with (n = 901) and without (n = 895) a disability were surveyed to examine their need and use of workplace supports including job accommodations, work modifications and health benefits. A multivariable logistic model was conducted to examine the relationship between disability status, disability type and sex/gender and unmet workplace support needs. The model included interaction terms between sex/gender × physical disability, sex/gender × nonphysical disability, and sex/gender × physical and nonphysical disability.

RESULTS

Among participants with a disability, 24% had a physical disability, 20% had a nonphysical disability (e.g., cognitive, mental/emotional or sensory disability) and 56% had both physical and nonphysical disability. Over half of the respondents were women (56%). Results from the multivariable model showed that nondisabled women were more likely to report unmet workplace support needs when compared to nondisabled men (odds ratio [OR] = 1.54, 95% confidence interval [CI], 1.13-2.10). Findings also showed an intersection between the number and type of disability and sex/gender; women with both a physical and nonphysical disability had the greatest likelihood of reporting unmet workplace support needs when compared to nondisabled men (OR = 2.73; 95% CI, 1.83-4.08).

CONCLUSIONS

Being a woman and having one or more disabilities can determine unmet workplace support needs. Strategies to address workplace support needs should consider the intersection between disability and sex/gender differences.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

INTRODUCTION

The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.

METHODS

Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.

RESULTS

Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.

CONCLUSIONS

Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.

Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults

BACKGROUND

Wearable activity trackers may facilitate walking for chronic pain management.

OBJECTIVE

We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity.

DESIGN

Randomized controlled pilot and feasibility trial.

SUBJECTS

Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls).

METHODS

Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration.

RESULTS

More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls.

CONCLUSIONS

With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

Functional Limitations, Social Integration, and Daily Activities in Late Life

OBJECTIVES

Disability in late life has been associated with increases in receiving care and loss of autonomy. The Disablement Process Model suggests that physical impairments lead to functional limitations that contribute to disabilities in managing household, job or other demands. Yet, we know surprisingly little about how functional limitations are related to activities throughout the day among community-dwelling adults, or the possible moderating role of social integration on these associations.

METHODS

Community-dwelling adults (N = 313) aged 65+ completed a baseline interview assessing their functional limitations, social ties, and background characteristics. Over 5 to 6 days, they answered questions about daily activities and encounters with social partners every 3 hours on handheld Android devices.

RESULTS

Multilevel logistic models revealed that functional limitations are associated with increased likelihood of activities associated with poor health (e.g., TV watching, medical appointments), and reduced likelihood of social activities, or physical activities, chores, or leaving the home. Most moderation analyses were not significant; family and friends did not mitigate associations between functional limitations and daily activities, with the exception of medical appointments. Individuals with functional limitations were more likely to attend medical appointments when with their social partners than when alone.

DISCUSSION

This study provided modest indication that functional limitations in community-dwelling older adults are associated with patterns of activity that may lead to further limitations, disability or loss of autonomy. Findings warrant longitudinal follow-up to establish subsequent patterns of decline or stability.

Inter-Individual Variability in Trajectories of Functional Limitations by Race/Gender

OBJECTIVE

Several theories emphasize that systematic interindividual divergence is a key feature of cohort aging and evidence for accumulative social inequality over the life course. While many have documented widening health gaps with age between subgroups, such divergence is only one aspect of the broader social inequality based on race and gender. This article examines patterns of interindividual variability in trajectories of functional limitations within each race/gender.

METHODS

Using data from the Health and Retirement Study (HRS)'s HRS cohort (born 1931-1941), I estimate growth curves of functional limitations with Level 2 heteroscedasticity, allowing interindividual variability to differ across 4 groups: white men, black men, white women, and black women. I examine race/gender differences in the age-based pattern of interindividual variability using an interquartile range of estimated individual trajectories.

RESULTS

Black men, white women, and black women have greater interindividual variability in functional limitations than do white men. Interindividual variability increases systematically with age at similar rates for all groups but black women.

DISCUSSION

Functional limitations become more heterogeneous with age for the entire cohort and for white men, white women, and black men. Future research should identify life-course processes that generate the race and gender patterning of interindividual variability in late-life health.

Putting cumulative (dis)advantages in context: Comparing the role of educational inequality in later-life functional health trajectories in England and Germany

BACKGROUND

The cumulative (dis)advantage (CAD) perspective more and more is examined in a comparative way, to highlight the role of context in generating inequality over the life course. This study adds to this field of research by examining trajectories of activities of daily living (ADL) in later life by educational level in a country comparison of England and Germany, emphasizing differing institutional conditions.

METHOD

Data used are the English Longitudinal Study of Ageing (ELSA; 11,352 individuals) and the German subsample of the Survey of Health and Retirement in Europe (SHARE; 5,573 individuals). Using population averaged Poisson panel regression models, 12-year trajectories of six birth cohorts are investigated, covering the age range of 50 to 90 years.

RESULTS

Respondents in England have a higher level of limitations at age 50, and more limited increases over age than in Germany. An educational gradient exists in both countries at age 50. Notably, the educational gradient increases for more recently born cohorts, but declines with increasing age in England, while in Germany educational differences increase for more recently born cohort only.

DISCUSSION

The current study indicates that CAD processes between educational groups are context sensitive. While England showed convergence of disparities with increasing age, in Germany no differential development was found.

Double Jeopardy Versus Double Benefit: The Role of Age and Leisure Activities in the Incidence of Disability Among Chinese Older Adults

Objectives: This paper analyzes the double jeopardy effect of age and double benefit of leisure activities in the incidence of disability. Methods: This study uses data from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2014. Disability status is measured by activities of daily living. Leisure activities include physical and social activities. A generalized linear mixed model with a time-lag design is used to analyze the trajectory of being disabled. Results: Older ages are associated with double jeopardy of disability: higher initial probability and faster pace. The double benefit of leisure activities is confirmed: lower initial probability and a slower pace of change in disability over time. The age pattern is substantially alleviated when leisure activities and other covariates are present. Discussion: Although the risk of disability rises with advancing age, the over-time trajectory can be flattened by engagement in leisure activities and other factors.

Promoting Men's Health Equity

Men's health equity is an area of men's health research and practice that combines the literature on men's health with that of health equity. More research is needed that describes how to intervene to promote men's health equity. This introduction to the American Journal of Men's Health special collection on promoting men's health equity was created to feature research that describes aspects of promising interventions that (a) are population-specific approaches that consider the unique biopsychosocial factors that affect the health of socially defined populations of men; or (b) use a comparative approach to close or eliminate gaps between socially defined groups of men and women and among socially meaningful groups of men that are unnecessary, avoidable, considered unfair and unjust, and yet are modifiable. The dozen papers from across the globe included in the special collection are grouped in three areas: conceptual approaches and reviews; formative research; and evaluation findings. The papers represent a diverse array of populations under the umbrella of men's health and a range of strategies to improve men's health from tobacco cessation to microfinance. The collection features a range of alternative masculinities that emerge from original research by the contributors that are used in novel ways in the interventions. This editorial argues that more qualitative research is needed to evaluate the intended and unintended findings from interventions. This editorial also highlights the benefits that men's health equity can gain from embracing dissemination and implementation science as a tool to systematically design, implement, refine, and sustain interventions.

Intersections of Adverse Childhood Experiences, Race and Ethnicity and Asthma Outcomes: Findings from the Behavioral Risk Factor Surveillance System

Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.

Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses

Intersectionality has received an increasing amount of attention in health inequalities research in recent years. It suggests that treating social characteristics separately—mainly age, gender, ethnicity, and socio-economic position—does not match the reality that people simultaneously embody multiple characteristics and are therefore potentially subject to multiple forms of discrimination. Yet the intersectionality literature has paid very little attention to the nature of ageing or the life course, and gerontology has rarely incorporated insights from intersectionality. In this paper, we aim to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. First we provide an overview of how intersectionality can be used in research on inequality, focusing on intersectional subgroups, discrimination, categorisation, and individual heterogeneity. We cover two key approaches—the use of interaction terms in conventional models and multilevel models which are particularly focussed on granular subgroup differences. In advancing a conceptual dialogue with the life course perspective, we discuss the concepts of roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. We conclude that the synergies between intersectionality and the life course hold exciting opportunities to bring new insights to unequal ageing and its attendant health inequalities.

Between loneliness and belonging: narratives of social isolation among immigrant older adults in Canada

Research points to a higher risk for social isolation and loneliness among new immigrant and refugee older adults. Our article draws from a research project that explored the everyday stories of ageing among 19 diverse immigrant older adults in Canada. To capture their experiences of loneliness and social isolation, we use four illustrative cases derived from a structural approach to life-story narrative. To these we apply the intersectional lifecourse analytical lens to examine how life events, timing and structural forces shape our participants’ experiences of social isolation and loneliness. We further explore the global and linked lives of our participants as well as the categories of difference that influence their experiences along the continua of loneliness to belonging, isolation to connection. Finally, we discuss how an understanding of sources of domination and expressions of agency and resistance to these forces might lead us to solutions.

Working and disability expectancies at older ages: The role of childhood circumstances and education

The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged.

Spousal Education and Cognitive Functioning in Later Life

OBJECTIVES

Numerous studies have documented the relationship between education and cognitive functioning at the individual level. Yet few studies have examined whether a spouse's education spills over to influence the other spouse's cognitive functioning. This study, therefore, investigates the association between spousal education and cognitive functioning, the pathways that may account for this association, and gender differences in this association.

METHOD

Growth curve models were analyzed by using longitudinal couple data from the Health and Retirement Study (N = 5,846 individuals).

RESULTS

More years of spousal education are associated with higher level of cognitive functioning at age 65 (γ000 = 0.0532, 95% confidence interval [CI] = 0.0163-0.0901) and slower decline in cognitive functioning in later adulthood (γ100 = 0.0054, 95% CI = 0.0026-0.0082). The positive association between spousal education and the level of cognitive functioning at age 65 is fully explained by economic resources. The association of spousal education with the rate of change in cognitive functioning decreases but remains significant after controlling for economic resources and health behaviors (γ100 = 0.0043, 95% CI = 0.0014-0.0072). The association between spousal education and cognitive functioning is similar for men and women.

DISCUSSION

Findings suggest that more years of spousal education may slow decline in cognitive functioning for men and women in later life.

Assessment of Racial Disparities in Mortality Rates Among Older Adults Living in US Rural vs Urban Counties From 1968 to 2016

Importance

Population-based mortality rates are important indicators of overall health status. Mortality rates may reflect underlying disparities in access to health care, quality of care, racial and geographical variations, and other socioeconomic factors associated with health. However, there is limited information on historical trends in mortality rates between older Black and White adults living in urban compared with rural communities.

Objective

To examine historical trends of mortality rates among White adults compared with Black adults and among rural residents compared with urban residents by comparing sex-specific age-adjusted all-cause mortality rates between older adults of both races who reside in rural and urban counties in the US.

Design, Setting, and Participants

In this county-level cross-sectional longitudinal study of US counties from January 1, 1968, to December 31, 2016, mortality data were obtained from the CDC WONDER database of the Centers for Disease Control and Prevention, and socioeconomic characteristics were obtained from the Area Health Resources Files of the US Health Resources and Services Administration. The study population included older adults (≥65 years) of Black and White ancestry living in 3131 rural and urban counties in the US. Using ordinary least squares regression analyses, race- and sex-specific trends in mortality rates with 95% CIs were examined, and trends adjusted by county-level socioeconomic characteristics using year and county fixed-effects were calculated. Data were analyzed from March 24 to May 10, 2020.

Exposures

Three geographic regions were examined: urban counties, rural counties adjacent to an urban county (rural-adjacent counties), and rural counties not adjacent to an urban county (rural-nonadjacent counties).

Main Outcomes and Measures

All-cause age-adjusted mortality rates of Black and White adults 65 years and older.

Results

For 1968, a total of 3076 counties (19 240 437 adults ≥65 years; 11 100 000 women [57.69%]; 1 484 747 Black individuals [7.74%]) were identified; of those, 1138 counties were urban, 1018 counties were rural adjacent, and 922 counties were rural nonadjacent. For 2016, a total of 3087 counties (46 400 000 adults ≥65 years; 25 800 000 women [55.72%]; 4 447 733 Black individuals [9.60%]) were identified; of those, 1163 counties were urban, 1020 counties were rural adjacent, and 904 counties were rural nonadjacent. Between 1968 and 2016, mortality rates per 100 000 persons decreased from 9063 to 4896 deaths (46%) among White men and from 6175 to 3760 deaths (39%) among White women. During the same period, mortality rates decreased from 8801 to 5477 deaths (38%) among Black men and from 6380 to 3960 deaths (38%) among Black women. However, the racial mortality gap increased among men living in rural counties after 1980. From 1968 to 2016, the mortality rate among White men decreased from 9063 to 4751 deaths (48%) in urban counties, from 9113 to 5338 deaths (41%) in rural-adjacent counties, and from 8971 to 5229 deaths (42%) in rural-nonadjacent counties. The mortality rate among Black men during the same period decreased from 8715 to 5368 deaths (38%) in urban counties, from 8924 to 6458 deaths (28%) in rural-adjacent counties, and from 9500 to 6941 deaths (27%) in rural-nonadjacent counties.

Conclusions and Relevance

Rural and urban socioeconomic differences were associated with mortality rate disparities among both White and Black women. However, rural vs urban disparities in mortality rates among men remained significant, especially among Black men living in rural counties. Notably, the current mortality rate of Black men living in rural areas is similar to that of White men living in urban and rural areas in the mid-1980s. Understanding the intersectional factors associated with health disparities may help to inform public health and clinical interventions.

A hidden vulnerable population: Young children up-to-date on vaccine series recommendations except influenza vaccines

Very young children (under 2 years old) have high risk for influenza-related complications. Children 6 months or older in the US are recommended to receive influenza vaccination annually, yet uptake is substantially lower than other routinely-recommended vaccines. Existing nationally-representative studies on very young child influenza vaccine uptake has several limitations: few examine provider-verified influenza vaccination (relying on parental report), few contain parental vaccine attitudes variables (known to be crucial to vaccine uptake), and none to our knowledge consider intersectionality of social disadvantage nor how influenza vaccine determinants differ from those of other recommended vaccines. This nationally-representative study examines provider-verified data on 7,246 children aged 6–23 months from the most recent (2011) National Immunization Survey to include the restricted Parental Concerns module, focusing on children up-to-date on a series of vaccines (the 4:3:1:3:3:1:4 series) but not influenza vaccines (“hidden vulnerability to influenza”). About 71% of children were up-to-date on the series yet only 33% on influenza vaccine recommendations by their second birthday; 44% had hidden vulnerability to influenza. Independent of parental history of vaccine refusal and a myriad of health services use factors, no parental history of delaying vaccination was associated with 7.5% (2.6–12.5) higher probability of hidden vulnerability to influenza despite being associated with 15.5% (10.8–20.2) lower probability of being up-to-date on neither the series nor influenza vaccines. Thus, parental compliance with broad child vaccine recommendations and lack of vaccine hesitancy may not indicate choice to vaccinate children against influenza. Examination of intersectionality suggests that maternal college education may not confer improved vaccination among non-Hispanic Black and Hispanic children despite that it does for non-Hispanic White children. Policymakers and researchers from public health, sociology, and other sectors need to collaborate to further examine how vaccine hesitancy and intersectional social disadvantage interact to affect influenza vaccine uptake in young US children.

Life course trauma and muscle weakness in older adults by gender and race/ethnicity: Results from the U.S. health and Retirement Study

Muscle weakness, as measured by handgrip strength, is a primary determinant of physical functioning and disability. There is a high burden of muscle weakness in the United States with close to 50 percent of older Americans meeting criteria for clinical muscle weakness. While previous racial/ethnic disparities have been documented among older adults, the extent to which lifecourse trauma shapes muscle strength trajectories is unknown. Using U.S. Health and Retirement Study (N = 20,472, Mean Age = 63.8 years) data on grip strength (2006-2014, up to 3 assessments) and retrospectively reported traumatic events, we fit gender-stratified growth curve models to investigate whether traumatic events experienced across the lifecourse or at distinct sensitive periods (childhood, early/emerging adulthood or mid-life) predicted later-life trajectories of grip strength. There was no association between cumulative trauma and trajectories of grip strength and the main effects for the life stage models were largely null. However, among White women, our results suggest that traumatic events experienced during childhood (β = -0.012; 95% CI = -0.024, 0.0004) compared to middle adulthood are associated with faster declines in grip strength in later life. Traumatic events reported during childhood was related to a slower decline in grip strength over time among Hispanic women compared to that for White women (β = 0.086, 95% CI = 0.044, 0.128). Among Black men, the association between traumatic events during early/emerging adulthood and age-related declines in grip strength was stronger for Black men than for White men (interaction β = -0.070; 95% CI = -0.138, 0.001). Traumatic events experienced during distinct life stages may influence later life declines in grip strength and exacerbate racial inequalities in later life. This study addresses an important gap by investigating the life course social determinants of later life muscle strength, which is a key driver of physical functioning and mobility.

Status Variation in Anticipatory Stressors and Their Associations with Depressive Symptoms

Members of structurally disadvantaged social groups report more frequent exposure to a variety of negative life events and chronic strains, yet little research has examined whether similar patterns exist for anticipatory stressors, or challenging circumstances that loom as potential threats in the future. This study uses data collected as part of a national survey of college seniors (N = 995) to examine how anticipatory stress regarding economic and residential security, exposure to traumatic events, and experiences of discrimination vary by gender identity, race-ethnicity, sexual orientation, and first-generation college student status. Consistent with stress theory, anticipatory stressors are more commonly reported by members of disadvantaged groups. Notably, variation in anticipatory stressors explains a nontrivial proportion of differences in depressive symptoms found across gender identity and sexual orientation categories. Findings signal the necessity of incorporating anticipatory stressors into research in the stress paradigm to further disentangle the contributions of social stressors to health disparities.

Racial discrimination and disability among Asian and Latinx populations in the United States

Purpose: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations.Materials and methods: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction.Results and conclusions: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.

HIV Stigma and Older Men's Psychological Well-Being: Do Coping Resources Differ for Gay/Bisexual and Straight Men?

OBJECTIVES

This study investigated whether sexual orientation moderated the mediation effects of coping resources (i.e., spirituality and complementary and integrative health [CIH] use) in the relationship between HIV stigma and psychological well-being (PWB) among older men with HIV (MWH).

METHOD

Data from the Research of Older Adults with HIV (ROAH) study was used (N = 640, Age 50+). Structural equation modeling (SEM) was employed to examine a coping resource mediation model. We used a multiple-group procedure to test moderation effects by sexual orientation.

RESULTS

HIV stigma was negatively associated with spirituality and PWB. HIV stigma accounted for a significant amount of variance in PWB, with significant indirect effects via spirituality, indicating a partial mediation. Chi-square difference tests supported the hypothesis that this mediation effect was moderated by sexual orientation. CIH use was not statistically significant.

DISCUSSION

HIV stigma's negative relationship with PWB was salient in both groups. Spirituality's buffer between HIV stigma and PWB was stronger in older gay/bisexual MWH compared to their heterosexual counterparts. With respect to HIV stigma, older gay/bisexual MWH exhibited a "crisis competence" in coping with stigma, perhaps through overcoming past homophobia related to their sexual minority status (i.e., homophobia).

Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study

OBJECTIVES

There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese.

DESIGN

Longitudinal panel study with 8 observation points from 1987 to 2012.

SETTING AND PARTICIPANTS

The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline.

METHODS

Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis.

RESULTS

Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years.

CONCLUSIONS AND IMPLICATIONS

We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.

Ethnic Differences in Functional Limitations by Age Across the Adult Life Course

Background

Despite compelling evidence from the United States of ethnic inequalities in physical functioning and ethnic differences in risk factors for poor physical functioning, very little is known about ethnic differences in the United Kingdom. Furthermore, the life stage at which these ethnic differentials are first observed has not been examined.

Methods

Using cross-sectional data from Wave 1 of the UK Household Longitudinal Study (UKHLS), we compared self-reported physical functioning among 35,816 White British, 4,450 South Asian and 2,512 African Caribbean men and women across different stages of adulthood (young adulthood, early middle age, late middle age, older age). Regression analyses examined ethnic differences in functional limitations, with adjustment for socioeconomic and clinical covariates. Ethnicity by sex and ethnicity by age-group interactions were examined, and subgroup heterogeneity was explored.

Results

Compared with White British adults over the age of 60, older South Asian men and women reported higher odds of functional limitations (odds ratio [OR] 2.77 [95% confidence interval {CI}: 2.00–3.89] and OR 3.99 [2.61–6.10], respectively); these ethnic differentials were observed as early as young adulthood. Young African Caribbean men had lower odds of functional limitations than White British men (OR 0.56 [0.34–0.94]), yet African Caribbean women reported higher odds of functional limitations in older age (OR 1.84 [1.21–2.79]).

Conclusions

There is an elevated risk of functional limitations relating to ethnicity, even in young adulthood where the impact on future health and socioeconomic position is considerable. When planning and delivering health care services to reduce ethnic inequalities in functional health, the intersectionality with age and sex should be considered.

Institutional and Individual Factors Affecting Health and Employment for Low-Income Women With Chronic Health Conditions

OBJECTIVES

This qualitative study explored risk and protective factors affecting employment and health among low-income older women with chronic health conditions or physical disabilities.

METHODS

The authors conducted a secondary data analysis of 14 intensive interviews with low-income older women with chronic health conditions who had participated in a federally funded training and employment program for workers aged 55 and older. Qualitative data were analyzed using thematic analysis.

RESULTS

The physical nature of the work and discrimination were risk factors, with unaccommodating work environments, ageism, and/or ableism, and internalized ageism identified as subthemes of discrimination. Protective factors, namely institutional supports (e.g., access to retraining, time management flexibility) enhanced health and self-confidence. Occupational demands matched with the capacity of the individual resulted in continued employment and improved health.

DISCUSSION

Working conditions can degrade health through exposure to mental and physical health risks, or support health through access to financial and interpersonal resources. Institutional supports such as workplace flexibility and retraining are crucial to obtaining a good fit between occupational demands and the capacity of individuals, enabling a positive relationship between employment and health. Legislation designed to prevent discrimination, enhance opportunities for lifelong learning, and encourage flexible work arrangements among low-income women with chronic health conditions may facilitate healthier working lives.

Race/ethnic Differences in Spatial Distance between Adult Children and Their Mothers

OBJECTIVE

This brief study examines race/ethnic differences in geographic distance to mothers among adults in the U.S.

BACKGROUND

Race/ethnic differences in rates of adult children living with their mothers in the U.S. are well documented but spatial distances beyond shared housing are not.

METHOD

Spatial distances between residential locations of adults 25 and older and their biological mothers are estimated using the 2013 Panel Study of Income Dynamics for Hispanics, blacks, and whites. Multinomial logistic regression models and nonlinear decomposition techniques are used to assess the role of demographic factors, socioeconomic status, and health of the child and mother in accounting for race/ethnic differences in adult child-mother proximity.

RESULTS

Blacks are more likely than whites to live with their mother and more likely to live within 30 miles but not coresident, whereas whites are more likely to live more than 500 miles away. Geographic proximity to mother is distinct for Hispanics with nearly one-third having their mother outside the U.S. Demographic, socioeconomic, and health factors account for the fact that blacks are about twice as likely as whites to live with their mother but do not fully account for large white-black differences in proximity outside the household. The single most important factor accounting for white-black differences is marital status for coresidence but education for proximity in the U.S. beyond coresidence.

CONCLUSION

New national estimates illustrate the complexity of race/ethnic differences in proximity to mothers that are not reflected in studies of coresidence.

Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers

Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7-45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.

Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans

OBJECTIVE

Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life.

METHOD

Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women.

RESULTS

Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS.

DISCUSSION

The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

Double Disadvantage in the Process of Disablement: Race as a Moderator in the Association Between Chronic Conditions and Functional Limitations

OBJECTIVES

This study evaluated (a) whether the association between chronic conditions and functional limitations vary by race/ethnicity, and (b) whether socioeconomic status accounted for any observed racial variation in the association between chronic conditions and functional limitations.

METHOD

The Health and Retirement Study data were used to assess whether race/ethnicity moderated the association between chronic conditions and functional limitations, and whether education, income, and/or wealth mediated any of the observed moderation by race/ethnicity.

RESULTS

Results from structural equation models of latent growth curves with random onset indicated that (a) the positive association between chronic conditions and functional limitations onset was larger for African Americans and Hispanics than it was for Whites, but (b) this difference largely persisted net of socioeconomic status.

DISCUSSION

African Americans and Hispanics endure a multiplicative double disadvantage in the early stages of the disablement process where they experience (a) a more rapid onset and higher levels of functional limitations, and (b) greater risk of functional limitation onset associated with chronic conditions compared to their White counterparts. Moreover, basic economic policies are unlikely to curtail the greater risk of functional limitations onset associated with chronic conditions encountered by African Americans and Hispanics.

Living Independent From Tobacco reduces cigarette smoking and improves general health status among long-term tobacco users with disabilities

BACKGROUND

People with disabilities disproportionately use tobacco and suffer associated negative health consequences. Research is needed to explore tobacco cessation programming for people with disabilities to counter these health disparities.

OBJECTIVE

We evaluated the impact of Living Independent From Tobacco on tobacco use, knowledge and attitudes about tobacco use, coping skills, and perceived health status among people with disabilities. We also assessed participants' subjective impressions at post-test.

METHODS

Living Independent From Tobacco was evaluated via train the trainer model at three Midwestern sites serving people with disabilities. Outcomes were assessed at four time points: pre- and post-test (n = 30), and again at 1-month (n = 26) and 6-months (n = 13).

RESULTS

Long-term tobacco users with disabilities significantly reduced tobacco use from pre-test to post-test (p = 0.003), and, compared to baseline, this reduction continued to be significant 1-month after the intervention (p = 0.02). From pre-test to post-test, perceived health status significantly improved (p = 0.0001). No significant changes were observed across time points for knowledge and attitudes about tobacco use nor for coping skills. Qualitative data revealed the importance of coping skills to mitigate the negative effects of nicotine withdrawal. Peer accountability was also noted as an important source of motivation for tobacco cessation.

CONCLUSIONS

Data from the present study provide evidence for the short-term effectiveness of Living Independent From Tobacco to reduce tobacco use and improve health status among people with disabilities. Qualitative data revealed the importance of coping skills and peer accountability to support tobacco cessation. Implications for tobacco cessation programming for people with disabilities are discussed.

Gradual Change, Homeostasis, and Punctuated Equilibrium: Reconsidering Patterns of Health in Later Life

Longitudinal methods aggregate individual health histories to produce inferences about aging populations, but to what extent do these summaries reflect the experiences of older adults? We describe the assumption of gradual change built into several influential statistical models and draw on widely used, nationally representative survey data to empirically compare the conclusions drawn from mixed-regression methods (growth curve models and latent class growth analysis) designed to capture trajectories with key descriptive statistics and methods (multistate life tables and sequence analysis) that depict discrete states and transitions. We show that individual-level data record stasis irregularly punctuated by relatively sudden change in health status or mortality. Although change is prevalent in the sample, for individuals it occurs rarely, at irregular times and intervals, and in a nonlinear and multidirectional fashion. We conclude by discussing the implications of this punctuated equilibrium pattern for understanding health changes in individuals and the dynamics of inequality in aging populations.

Longer-but Harder-Lives?: The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant-Native Health Disparities from Midlife through Late Life

Though Hispanics live long lives, whether a "Hispanic paradox" extends to older-age health remains unclear, as do the social processes underlying racial-ethnic and immigrant-native health disparities. Using data from the Health and Retirement Study (2004-2012; N = 6,581), we assess the health of U.S.- and foreign-born Hispanics relative to U.S.-born whites and blacks and examine the socioeconomic, stress, and behavioral pathways contributing to health disparities. Findings indicate higher disability, depressive, metabolic, and inflammatory risk for Hispanics relative to whites and similar health profiles among Hispanics and blacks. We find limited evidence of a healthy immigrant pattern among foreign-born Hispanics. While socioeconomic factors account for Hispanic-white gaps in inflammation, disparities in other outcomes persist after adjustment for socioeconomic status, due in part to group differences in stress exposure. Hispanics may live long lives, but their lives are characterized by more socioeconomic hardship, stress, and health risk than whites and similar health risks as blacks.

Trajectories of Work Disability and Economic Insecurity Approaching Retirement

OBJECTIVES

In this article, we examine the connection between trajectories of work disability and economic precarity in late midlife. We conceptualize work disability as a possible mechanism linking early and later life economic disadvantage.

METHODS

We model trajectories of work disability characterized by timing and stability for a cohort of Baby Boomers (22-32 in 1981) using 32 years of data from the Panel Study of Income Dynamics and latent class analysis. Measures of childhood disadvantage are included as predictors of work disability trajectories, which are subsequently included in logistic regression models predicting four economic outcomes (poverty, asset poverty, home ownership, and pension ownership) at ages 54-64.

RESULTS

Childhood disadvantage selected individuals into five distinct classes of work disability that differed in timing and stability. All of the disability trajectories were associated with an increased risk of economic insecurity in late midlife compared to the never work disabled.

DISCUSSION

This study contributes to the aging literature through its incorporation of the early life origins of pathways of disability and their links to economic outcomes approaching retirement. Findings suggest work disability is anchored in early life disadvantage and is associated with economic insecurity later in life.