Do conditional cash transfers reduce hypertension?

Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies have found positive impacts on schooling, the nutritional and health status of children and adolescents, and household consumption. However, the effects on the health of older adult beneficiaries have been particularly understudied. In this paper we analyze the effects of Progresa on middle-aged and older adult health, focusing on a high prevalence chronic condition: hypertension. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and use of treatment drugs. However, we did not find significant changes in uncontrolled hypertension as measured by systolic and diastolic blood pressure biomarkers in household survey data. Thus, while cash transfer programs may facilitate financial access to healthcare visits and the ability to buy prescribed medicines, by itself the program might not improve hypertension outcomes without complementary healthcare system follow-up to ensure dosage titration and medication adherence.

The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants

BACKGROUND AND OBJECTIVES

The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States.

RESEARCH DESIGN AND METHODS

Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.

RESULTS

Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants-Black, Hispanic, and Asian/Pacific Islander-even when holding socioeconomic status constant.

DISCUSSION AND IMPLICATIONS

Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.

20 years of the Mexican Health and Aging Study

The Mexican Health and Aging Study (MHAS) is a longitudinal study using a national sample of approximately 15,000 community-dwelling adults aged 50 years old and older in Mexico. Spanning over 20 years (2001-2021), six waves of data collection establish the MHAS as the leading data platform for the study of aging in Latin America.

Determinants of retirement of formal and informal sector workers in Mexico: the role of health and economic security

OBJECTIVE

We examine the socioeconomic and health drivers of retirement decisions and compare these determinants between formal and informal sector workers in Mexico.

MATERIALS AND METHODS

Using data from the Mexican Health and Aging Study 2012 and 2015, we estimate conditional probit models of retirement using sociodemographic, health, health care utilization, health insurance, private pensions, and social security systems covariates. The Institutional Review Board at the University of Southern California reviewed and approved the research (IRB # UP-15-00023).

RESULTS

We find that the social security systems are an important determinant for retirement age for formal sector workers. The informal sector workers, who lack access to retirement benefits of the social security system, make retirement decisions mainly based on health and access to health insurance through social security.

CONCLUSION

Despite the lack of access to social security benefits, informal sector workers do not respond strongly to socioeconomic factors in determining the timing of retirement. Strengthening access to better health care services could improve health, extend working lives, and promote healthy aging for workers in the informal sector.

Assigning lifetime occupation domains for older Mexicans: MHAS-O*NET linkage protocol

OBJECTIVE

We developed a MHAS (Mexican Health and Aging Study) and O*NET (Occupational Information Network) linkage to allow global researchers using MHAS data to assign lifetime occupation domains for older Mexicans.

MATERIALS AND METHODS

Three bilingual raters independently matched 440 records with 132 unique occupation codes from the 2012 MHAS. We used a modified Delphi technique to reach agreements. To assess reliability, we compared the distribution of observations between the MHAS file and the MHAS-O*NET linked file across five job categories (upper white collar, lower white collar, upper blue collar, low blue collar, and agriculture/fishing/forestry). The Institutional Review Board at the University of Texas Medical Branch reviewed and approved the research (IRB # 21-0268).

RESULTS

Using the developed 1:1 MHAS-ONET linkage, consistency between MHAS and ONET was 97.4% across the five job categories.

CONCLUSION

This MHAS-O*NET linkage will allow researchers to analyze the association between lifetime occupation and multiple dimensions of health, functionality, and retirement determinants for a low-middle income country with a large proportion of workers in the informal sector.

Migration, work, and retirement: the case of Mexican-origin populations

Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico.

NonContributory Pensions, Functional Limitations, and Unpaid Family Care for Older Adults in Mexico

Objectives: We explore the effects of non-contributory pensions on functional limitations and receipt of unpaid family care by gender and frequency of pension payment. Methods: We employ a difference-in-differences estimator to identify the causal effects of non-contributory pension programs disbursed monthly or every two months for adults 70 years and older in the state of Yucatan, Mexico. Results:The monthly payment program led to lower difficulties in functional limitations and less receipt of help from family or relatives for older men and women as compared to the bimonthly program. We found a larger decline on receipt of family care for older women than for men. Discussion:Our results suggest that more frequent pension payments may have greater health benefits for recipients. They also highlight the need for greater understanding of policies that prevent or delay functional limitations and that could indirectly alleviate unpaid caregiver burden.

Long-Term Effects of Social Insurance on Adult Mortality: Evidence From Three Social Programs in Mexico

Research on the mortality effects of social insurance programs for older adults has generated conflicting results. Some studies suggest important health benefits, others find no effects, and still others find unintended adverse effects potentially linked to pathways such as increased obesity. Evidence has focused predominantly on short-run effects rather than net long-run mortality effects and their effects on the health of older adults has been particularly understudied. Mexico offers a unique opportunity for studying the long-run effects of social programs on adult mortality. Within a ten-year period, Mexico introduced the following influential social insurance programs: Progresa conditional cash transfer (CCT) program in 1997, 70 y más unconditional cash transfer (UCT) program for older persons in 2007, and Seguro Popular, a public health insurance program (PHI) for the uninsured, in 2004. In this paper we analyze effects on mortality for middle-age and older adults, by gender, 10-20 years after program implementation.

Framing Binational Challenges of Mental and Cognitive Health Care in Mexican-Origin Older Adults: Consensus Findings

Growth in older populations, and hence in the number of persons living with dementia, is particularly rapid for individuals of Mexican origin living in the U.S. and Mexico. In order to identify influences on cognitive health in this diverse population, the University Texas at Austin and Mexican National Institute of Geriatrics (INGER) organized their second Bridging Conference titled: "Framing Challenges of Cognitive and Mental Health Care in Mexican-origin Older Adults in Mexico and the U.S". In this presentation, we highlight the results of a consensus-building session, during which bi-national expert opinions were generated and synthesized addressing gaps in research, knowledge, and policy, as well as the setting of priorities for immediate action and future research. Reducing barriers to adequate care for those aging-in-place with dementia was a central theme of the identified priorities. Critical areas of identified need, more specifically, included reducing social isolation, caregiver burden, and diminishing retirement income.

Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.

Health and social correlates of dementia in oldest-old Mexican-origin populations

INTRODUCTION

Substantial gaps in research remain across oldest-old ethnic populations while the burden of dementia increases exponentially with age among Mexican and Mexican American older adults.

METHODS

Prevalence and correlates of dementia among individuals ≥82 years of age were examined using two population-based cohort studies: The Mexican Health and Aging Study (MHAS, n = 1078, 2012) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, n = 735, 2012-2013). The analytic MHAS and HEPESE samples had an average age of 86.4 and 88.0 years, 1.2 and 1.8 women to men, and 2.7 and 5.1 average years of education, respectively.

RESULTS

We identified 316 (29.2%) and 267 (36.3%) cases of likely dementia in the MHAS and HEPESE cohorts, respectively. For Mexicans but not Mexican Americans, age-adjusted prevalence rates of likely dementia were higher in women than men. For both populations prevalence rates increased with age and decreased with education for Mexican Americans but not for Mexicans. In both populations, odds of likely dementia increased with age. Health insurance for the low-income was significantly associated with higher odds of likely dementia for Mexican American men and women and Mexican women but not men. Living in extended households increased the odds of likely dementia in women, but not in men for both studies. Multiple cardiovascular conditions increased the odds of likely dementia for Mexicans but not for Mexican Americans.

DISCUSSION

Our study provides evidence of the high burden of dementia among oldest-old Mexicans and Mexican Americans and its association with health and social vulnerabilities.

Likely Dementia and Its Implication for Support Among the Oldest-Old in Mexico and the United States

This study examines sources of vulnerabilities to dementia in low resource populations in two specific contexts—Mexico and the United States. Data are drawn from comparable waves of the Mexican Health and Aging Study (MHAS) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) in 2012, which include representative samples of the oldest-old (82 and over), the fastest growing segment of the populations worldwide. Likely dementia prevalence is 30.9% (±0.46SD) for Mexicans in Mexico and 36.3% (±0.48SD) for Mexicans in the U.S. Odds of likely dementia in both populations were increased by age, living in extended households, depressive symptoms, and Seguro Popular and Medicaid receipt. Being female and having comorbid cardiovascular conditions were also associated with likely dementia but only for older Mexicans. There is a need to strengthen the caregiving capacity of memory care services in low resource communities in Mexico and the U.S.

Supplemental income program design: A cluster-randomized controlled trial to examine the health and wellbeing effects on older adults by gender, duration, and payment frequency

BACKGROUND

We documented results from a cluster-randomized controlled trial we designed to supplement incomes in poor towns among adults 70 or older. We analyzed effects on health by gender, persistence over time, and variation by payment frequency.

METHODS

We compared supplemental income effects over an 18-month period for two towns in Yucatan, Mexico: Valladolid, where eligible individuals received a monthly income supplement over the entire analysis period, and Motul, a demographically matched control town, where eligible individuals received a bimonthly income supplement over the last 12 months of the analysis period. While differing in frequency of payment, supplements provided similar levels of income. We conducted three surveys of recipients: (1) at baseline, (2) six months after baseline, and (3) 18 months after baseline.

RESULTS

The primary outcomes we examined were peak expiratory flow, hemoglobin level, and verbal recall. The secondary outcomes were health care use and food availability. We found health benefits persisted for at least eighteen months for the monthly income supplement, with both males and females benefiting. Bimonthly income supplements had smaller health benefits.

CONCLUSIONS

Older people in the developing world who lack social security benefits and health care may benefit most from monthly income programs. The greater payment frequency of monthly programs may influence how household resources are allocated. Supplemental income programs are common in low- and middle-income countries; hence, our results have implications for program design in many nations.

Gender Differences in Cognitive Function among Older Mexican Immigrants

This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the "risk factor hypothesis"); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the "survival bias hypothesis"); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the "differential selection hypothesis"); and whether male immigrants are better acculturated to life in the United States than female immigrants (the "acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition.

Living Arrangements and Supplemental Income Programs for Older Adults in Mexico

Living arrangements often reflect important quality-of-life indicators for elderly adults. In particular, increased income can prompt changes in household living arrangements for elderly adults. Using a differences-in-differences approach, we examine whether a supplemental income program in Mexico for adults aged 70 and older influenced household size and composition. We compare outcomes at baseline and at six-month follow-up for elderly adults in the treatment group with those in the control group that did not participate in the program. We find that household size increased by 3% in the treatment group relative to the control group. We also find a statistically significant increase in the number of girls aged 6-11 in the household, likely the granddaughters or great-granddaughters of program recipients. Increases in household size were greatest for adults aged 70-79, couples, households receiving two or more supplemental incomes, and households in the top income tercile. Household size did not increase for households of adults aged 80 and older, singles, households with only one supplemental income recipient, and households not in the top income tercile. These results suggest that when older adults have more income, they use part of this income to house their grandchildren.

Do Income Supplemental Programs for Older Adults' Help Reduce Primary Caregiver Burden? Evidence from Mexico

In countries such as Mexico without formal public long-term care policies, informal care becomes the main source of support for older adults. Alternative social programs, such as supplemental income programs, for older adults could alleviate caregiver burden, especially if supplemental income were to be used for paid care or to compensate non-paid family caregivers. This work is the first to analyze the effects of a supplemental income program for older adults on primary caregiver burden. To identify how such a program might affect caregiver burden, we analyze rich panel data on 433 adults 70 years and older in two communities, one receiving a supplemental income program and the other not, in Yucatan, Mexico. Data were collected in 2008 and 2009 among treatment and control groups before and 6 months after program introduction. We employ a difference-in-differences approach. In our sample, most care is provided by non-paid female caregivers. We find that individuals in both the treatment and control groups received fewer hours of care over time. The decrease was lower for older adults who received the supplemental income, but the difference with those who did not was not statistically significant. We also observe few changes on caregiving burden; even after program introduction, more than 98% of caregivers remained unpaid and the same primary caregiver remained. Altogether, our work suggests supplemental income programs have negligible effects on caregiving, making evident the urgent need for other strategies to support non-paid caregivers who bear most of the burden for old-age care in Mexico.

The effect of old-age pensions on health care utilization patterns and insurance uptake in Mexico

Introduction

As old-age pensions continue to expand around the world in response to population ageing, policymakers increasingly wish to understand their impact on healthcare demand. In this paper, we examine the effects of supplemental income to older adults on healthcare use patterns, expenditures and insurance uptake in Yucatan, Mexico.

Method

We use a longitudinal survey for individuals aged 70 or older and an individual fixed-effects difference-in-difference approach to understand the effect of an income supplement on healthcare use patterns, out-of-pocket expenditures and health insurance uptake patterns.

Results

The implementation of the old-age pension was associated with increased use of healthcare with nuanced effects on the type of care. Old-age pensions increase the use of formal healthcare by 15 percentage points (95% CI 6.1 to 23.9) for those with healthcare use at baseline and by 7.5 percentage points (95% CI 3.7 to 11.3) for those without healthcare use at baseline. We find no evidence of greater out-of-pocket expenditures, likely because old-age pensions were associated with a 4.2 percentage point (95% CI 1.5 to 6.9) increase in use of public health insurance.

Conclusion

Old-age pensions can shift healthcare demand towards formal services and eliminate financial barriers to basic care. Pension benefits can also increase the uptake of insurance programmes. These results demonstrate how social programmes can complement each other This highlights the potential role of old-age pensions in achieving universal health coverage for individuals at older ages.

OLD AND FORGOTTEN? CARE FOR ELDERS IN MEXICO AND THE U.S

The United States and Mexico differ greatly in the organization and financing of their old-age welfare states. They also differ politically and organizationally in government response at all levels to the needs of low-income and frail citizens. While both countries are aging rapidly, Mexico faces more serious challenges in old-age support that arise from a less developed old-age welfare state and economy. For Mexico, financial support and medical care for older low-income citizens are universal rights, however, limited fiscal resources for a large low-income population create inevitable competition among the old and the young alike. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for the elderly, older Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. These institutional and financial problems to aging are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. In this interdisciplinary panel, the authors of five papers deal with the following topics: (1) an analysis of old age health and dependency conditions, the supply of aging and disability services, and related norms and policies, including the role of the government and the private sector; (2) a binational comparison of federal safety net programs for low-income elderly in U.S. and Mexico; (3) when strangers become family: the role of civil society in addressing the needs of aging populations; and (4) unmet needs for dementia care for Latinos in the Hispanic-EPESE.

A BI-NATIONAL COMPARISON OF FEDERAL SAFETY NET PROGRAMS FOR LOW-INCOME ELDERLY IN THE U.S. AND MEXICO

Population aging in Mexico as in the United States is expected to accelerate over the next thirty years, and the proportion of individuals 65 and older will triple to approximately 20 percent by 2050 in both nations. Older people of Mexican origin are at high risk of protracted periods of poor health, a reality exacerbated by poverty. We use the Health and Retirement Study (HRS 2012-2014, N= 2,575) and Mexican Health and Aging Study (MHAS 2012-2015; N=16,131) to compare profiles of older Mexican-origin recipients of income supplements. We find Mexican immigrants are lower-income, less healthy, and less likely to receive supplements than Mexican origin in U.S. In contrast, return migrants are more likely to receive supplements than non-migrants in Mexico. Income supplement recipients are more likely to receive Medicaid and Seguro Popular. We discuss implications of financing safety net programs and the potential dependency burden in two countries aging rapidly.

Short-Term Impact of Income on Cognitive Function: Evidence From a Sample of Mexican Older Adults

Objective: To estimate the short-run (6-9 months) impact and mediating mechanisms of an intervention providing supplemental income to individuals 70 years and above from the Mexican state of Yucatan on markers of cognitive functioning (immediate and delayed word recall). Method: Regression-adjusted difference-in-differences (DID) analysis using baseline and follow-up data collected at treatment and control sites from an experiment. Results: The intervention improved immediate and delayed recall scores for men and women. We found no effects on diagnoses of dementia risk factors, depression, and activities of daily living (ADLs). The intervention increased health care use and decreased anemia for men and women, and improved food availability for men. The effects on cognitive outcomes were mediated by health care use for both men and women, and food availability for men. Discussion: In low- and middle-income countries, supplemental income for elderly may be an effective strategy to improve cognitive function by increasing food security and health care utilization.

Non-contributory pension programs and frailty of older adults: Evidence from Mexico

Non-contributory pension programs in the developing world seek to provide older adults with an income that may improve their health and wellbeing in old age by enabling access to health care and better nutrition. There is no previous evidence of the effects of non-contributory pensions on frailty, a comprehensive measure of health and well-being of the oldest old. We aimed to estimate the effects of non-contributory pension programs on frailty of older adults in the state of Yucatan, Mexico. We use rich panel data, including objective markers and self-reported assessments of health and well-being, for 944 adults at least 70 years of age in two communities of Yucatan, Mexico. The first wave was collected in 2008; the second wave was collected in 2010, 18 months after implementation of a monthly state pension in one community and 12 months after a federal pension paid every two months in the other. We found the state pension led to a statistically significant decrease in the severity of frailty for women, but the federal pension was associated with an increase. We found no statistically significant change in the frailty index for men in either community. Among explanations for these findings are monthly payments being more likely to be spent on health care, medicines, and more regular food expenditures, enabling women who previously lacked independent means of support to increase their longer-term health. The federal program paid every two months led to irregular patterns of food expenditure and increased ownership of durable goods but had no effects on health care utilization, subsequently leading to deterioration in longer-term health for women.

Understanding the Racial/Ethnic Gap in Bank Account Ownership among Older Adults

The observed racial/ethnic gap in bank account ownership among older adults is substantial. We investigate socioeconomic, cognitive, and cultural barriers underling it. As additional potential barriers are accounted for, the residual gaps in financial inclusion with respect to Whites are reduced by 19% for blacks and 46% for Hispanics. We find that citizenship and "taste for privacy" play a limited role for both minority groups, while real asset ownership, health, cognitive ability, and cultural hurdles contribute substantially to the gap. For Hispanics, language barriers explain most of the gap, while neighborhood-level socioeconomic characteristics are more salient for blacks. We also examine how the racial/ethnic composition of couples influences financial decisions. We estimate a significantly smaller residual gap between "mixed" and white couples than between minority and white couples. We provide empirical evidence suggesting that, other things equal, mixed couples are less concerned with the cultural/psychological barriers facing minority couples.

Social Security Contributions and Return Migration Among Older Male Mexican Immigrants

Purpose

For decades, scholars have studied the effects of immigration on the U.S. social security system. To date, this research has been primarily limited to migrants within the United States and does not consider those who return to their countries of origin. We estimate the proportion of male Mexican return migrants who contributed to the U.S. social security system and analyze their socioeconomic characteristics and migration histories. We also estimate the proportion that receive or expect to receive U.S. social security benefits.

Design and Methods

Using probit regression on the 2012 Mexican Health and Aging Study (MHAS), we describe the predictors of having contributed to the U.S. social security system among Mexican males in Mexico aged 50 years and older who at some point lived in the United States.

Results

We find that 32% of male return migrants reported having contributed to the U.S. social security system, but only 5% of those who contributed, received or expected to receive benefits. Those who reported having contributed spent more years in the United States and were more likely to be U.S. citizens or legal permanent residents than those who did not contribute.

Implications

Immigrants often pay Old-Age, Survivors, and Disability Insurance taxes using legitimate or illegitimate social security numbers and return to their home countries without collecting U.S. social security benefits.

Designing Cash Transfer Programs for an Older Population: The Mexican Case

Aging populations and the prevalence of poverty in old age have led to the introduction of noncontributory pensions in many countries. We consider a number of alternative targeting approaches and simulate their effects in an empirical application in the State of Yucatan, Mexico. We compare the approaches with respect to leakage, under-coverage, and their effects on government budgets. We are also able to compare the simulated effects of one alternative with the observed effect of a recently introduced demogrant and find that the simulation is a close approximation of the empirical outcomes. We discuss issues of implementation and political feasibility.

Consumption Smoothing and Frequency of Benefit Payments of Cash Transfer Programs

We analyze two noncontributory Mexican pension programs for the elderly. Both paid similar amounts, but one paid monthly while the other paid every two months. The Life Cycle Hypothesis suggests frequency of benefits payments should not affect consumption smoothing, but we find the monthly program was more effective in smoothing food expenditure. It also increased doctor visits and reduced the incidence of hunger spells. Under the bimonthly program, expenditures on food significantly decline between paychecks but ownership of durable goods increased. This suggests the importance of payment frequency in social programs.

Retirement Planning Among Hispanics: In God's Hands?

We conducted a qualitative study on retirement preparedness among middle-aged and older low-income Hispanics in Los Angeles. Data were derived from four focus groups conducted in the greater Los Angeles area. Findings demonstrate how behavioral and cultural factors-family experiences, religiosity, and denial of retirement-explain the lack of savings and preparedness for retirement. Findings also indicate that the majority of participants want to be economically independent and to keep working until they are unable to do so. Participants helped their parents financially but did not feel comfortable asking their own children for help. Instead, participants placed their survival in retirement "in God's hands."

Costs of Extending the Noncontributory Pension Program for Elderly: The Mexican Case

Population aging coupled with high poverty rates among older persons and a lack of access to social-security benefits or traditional support systems have led governments in low and middle-income countries to introduce non-contributory pension programs for the elderly. This article reviews a non-contributory pension program introduced in Mexico in 2007 that has since expanded greatly. We use a variety of sources to estimate current and future costs of this program.

Ownership of a bank account and health of older Hispanics

We study health effects of financial inclusion, particularly ownership of a checking account of older minorities, with focus on Hispanics. Using data from the Health and Retirement Study from 2000 to 2012, we find that, for Hispanics, being banked has a positive effect on mental health but is not associated with effects on physical health. Mental health benefits are likely to be larger for those who face greater hurdles to access formal financial institutions. Hispanics in less well-off neighborhoods and with below-median wealth appear to experience the greatest mental-health benefits associated with ownership of a checking account.

Culturally Competent Informed-Consent Process to Evaluate a Social Policy for Older Persons With Low Literacy: The Mexican Case

The informed-consent process seeks to provide complete information to participants about a research project and to protect personal information they may disclose. In this article, we present an informed-consent process that we piloted and improved to obtain consent from older adults in Yucatan, Mexico. Respondents had limited fluency in Spanish, spoke the local Mayan language, and had some physical limitations due to their age. We describe how we adapted the informed-consent process to comply with U.S. and Mexican regulations, while simplifying the forms and providing them in Spanish and Mayan. We present the challenges and lessons learned when dealing with low-literacy older populations, some with diminished autonomy, in a bilingual context and a binational approach to the legal framework.

Sociodemographic characteristics associated with alcohol use among low-income Mexican older adults

BACKGROUND

Despite increasing concern about the quality of life of older adults, little is known about characteristics associated with health risk behaviors among older adults in middle-income countries. This study relied on unique longitudinal data to examine the relationship between sociodemographic characteristics and alcohol use among low-income older adults, one of the fastest-growing populations worldwide.

METHODS

This multilevel longitudinal analysis involved three waves of data (2008-2010) from 2,351 adults aged 70 or older in Yucatán, Mexico. Multilevel regressions models were used to test interactions among gender, speaking Mayan (indigenous language), and socioeconomic status to understand conditions associated with the odds of current alcohol use and the frequency and amount of alcohol use.

RESULTS

Half of the participants in this study report consuming alcohol in their lifetime, 21.58 % of whom were current alcohol users. Older adults reported consuming alcohol 1.15 days a week and 1.60 drinks per day. Speaking Mayan was associated with lower odds of current alcohol use. However, men who spoke Mayan reported higher odds of drinking alcohol compared to women and non-Mayan (Spanish) speakers. The positive relationship between socioeconomic status and alcohol use was also moderated by gender (male).

CONCLUSIONS

Findings show that older and Mayan populations had lower odds of drinking in Yucatán, Mexico, whereas men were at highest risk of drinking alcohol, after adjusting for ethnic culture and socioeconomic status. Implications for health policy and epidemiological studies on substance use among older adults residing in low-income settings are discussed.

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Recently, the phenomenon of young people not in education, employment or training (NEET) has come to the fore due to the risks associated to this situation. The contribution of this paper is in its analysis of this population's composition, dynamics, poverty patterns, individual and family characteristics, as well as projections for 2030. In addition, we propose a classification for NEET's that could be used for the design of public policies and that was used to identify that this population will tend to decreased due to the proportion of women who study and join the labor force and that, in the future, the unemployed will outnumber other groups.

How Do Management Fees Affect Retirement Wealth under Mexico's Personal Retirement Accounts System?

In 1997, Mexico transformed its pay-as-you-go social security system to a fully funded system with personal retirement accounts, including management fees. This article examines changes in retirement wealth resulting from this new system. It shows that management fees have drained a significant proportion of individuals' retirement wealth and have increased the number of persons claiming a government-subsidized minimum pension, particularly from the time the system was introduced in 1997 until adjustment to management fees in 2008. Since 2008, retirement wealth accumulation has been similar to that of the previous system. En 1997, México transformó su sistema de pensiones basado en cotizaciones individuales a uno de ahorro para el retiro que incluyen cuotas por la administración de las cuentas. El presente estudio examina los cambios en el monto de las pensiones como resultado de la introducción del nuevo sistema. Los resultados muestran que las cuotas de administración han drenado una proporción significativa del ahorro para el retiro de los individuos por lo que ha aumentado el número de personas que solicita la pensión mínima garantizada subsidiada por el gobierno desde que se introdujo el sistema en 1997 hasta que se hicieron ajustes en las cuotas de administración de los fondos de pensiones en 2008. A partir de 2008, la acumulación del ahorro para el retiro ha sido similar que la del sistema anterior.

Male Labor Force Participation and Social Security in Mexico

Labor-force participation among Mexican males in their early retirement years (60 to 64 years of age) has decreased in recent decades, from 94.6 percent in 1960 to 65.2 percent in 2010. Similar trends are evident elsewhere in Latin America, and have occurred in the developed world. Such trends pose challenges to financial sustainability of social security systems as working-age populations decrease and those in retirement increase both because of demographic trends and decisions to take early retirement. In this study, we find that the Mexican social security system provides incentives to retire early. The retirement incentives of the Mexican social security system affect retirement behavior, and may be one of the main contributors to early retirement decisions, particularly for lower-income populations. We simulated the effect of the reform from a Pay-As-You-Go (PAYG) to the new Personal Retirement Accounts (PRA) system and we find that the PRA system also provides incentives to early retirement. Further analysis is needed to assess the financial sustainability of the social security system and financial security in old age for the largest cohorts in Mexico that will begin to retire by 2040.

Retirement and health benefits for Mexican migrant workers returning from the United States

In the absence of a bilateral agreement for the portability and totalization of social security contributions between the United States and Mexico, this article examines the access to pension and health insurance benefits and employment status of older Mexican return migrants. We find that return migrants who have spent less than a year in the United States have a similar level of access to social security benefits as non-migrants. Return migrants who have spent at least a year in the United States are less likely to have public health insurance or social security benefits, and could be more vulnerable to poverty in old age. These results inform the debate on a bilateral social security agreement between the United States and Mexico to improve return migrants' social security.

Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States

OBJECTIVE

Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status.

METHOD

Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome.

RESULTS

The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators.

DISCUSSION

Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

Living Longer in Mexico: Income Security and Health

This analysis of aging and income security in Mexico establishes that the older population in Mexico is increasing quickly and that this population is especially vulnerable to poverty. Mexican citizens are living longer and overall have experienced an improvement in the quality of life compared to that of prior generations. However, this study demonstrates that social improvements are not affecting the daily lives of all persons equally. The authors attempt to uncover and highlight those differences. One of the primary challenges facing Mexico is a growing older population. The demographic transition in Mexico combined with the lack of formal sources of income in retirement place many older persons in a state of financial insecurity. The information contained in this study and the proposed policy research areas are intended to enlarge the portfolio of options for older Mexicans. The authors analyze wealth and sources of income during retirement, the relationship between health and wealth, urban and rural disparities, and the impact of migration spells to the United States on wealth accumulation and health insurance in Mexico.

Personal Retirement Accounts and Saving

Aging populations are leading countries worldwide to social security reforms. Many countries are moving from pay-as-you-go to personal retirement account (PRA) systems because of their financial sustainability and positive impact on private savings. PRA systems boost private savings at a macro level by converting a government liability into financial wealth managed by private fund managers. However, at a micro level, changes in retirement wealth affect individuals' saving and consumption patterns through their working lives. Retirement wealth increased for lower-income workers after Mexico introduced PRAs, crowding out saving, increasing consumption, and offsetting some of the PRA effect on private savings. (JEL D14, E21, H55, J26, O16).

Changes in Consumption at Retirement: Evidence from Panel Data

Previous empirical literature has found a sharp decline in consumption during the first years of retirement, implying that individuals do not save enough for their retirement. This phenomenon is called the retirement consumption puzzle. We find no evidence of the retirement consumption puzzle using panel data from 1980 to 2000. Consumption is defined as nondurable expenditure, a more comprehensive measure than only food used in many of the previous studies. We find that food expenditure declines at retirement, which is consistent with previous studies.

Platelet function and biosynthesis of prostacyclin and thromboxane A2 in whole blood after aspirin administration in human subjects

Small doses of aspirin have been shown to inhibit platelet thromboxane A2 while sparing vascular prostacyclin synthesis. Because leukocytes generate prostacyclin and participate in thrombosis along with platelets, the effects of three different doses of aspirin (40, 325 and 650 mg) on platelet function as well as on endogenous biosynthesis of thromboxane A2 and prostacyclin in whole blood were examined. In normal volunteers given a single 40 mg dose of aspirin, platelet aggregation and adenosine triphosphate release were inhibited for 24 hours. In contrast, platelet function was inhibited for 4 to 7 days in volunteers given 325 or 650 mg of aspirin. Platelet and whole blood generation of thromboxane A2 was inhibited less than 60% by the 40 mg dose, but almost completely by both the 325 and 650 mg doses. Likewise, whole blood generation of prostacyclin was inhibited 70% by the 40 mg dose and over 90% by the larger doses. Inhibition of thromboxane A2 as well as of prostacyclin was evident for 4 days with the 40 mg dose and for 7 days with the larger doses. Decreases in whole blood thromboxane A2 and prostacyclin with any dose of aspirin were of similar magnitude. These data indicate that aspirin in doses of 40 to 650 mg inhibits platelet function and biosynthesis of thromboxane A2 and prostacyclin in whole blood in human beings in a dose-dependent fashion.

Effects of nitrendipine and hydralazine on plasma catecholamines in essential hypertension

We compared the efficacy and safety of nitrendipine with that of hydralazine in 21 subjects with essential hypertension. Nitrendipine or hydralazine was given in a double-blind manner after a placebo period. Dose was titrated to diastolic blood pressure (BP) less than or equal to 90 mm Hg and the dose established during titration was continued for 5 to 7 wk. Both supine and erect BP were decreased by both drugs, but heart rate was affected only minimally. Myocardial oxygen demand decreased only with nitrendipine (P less than 0.05), although the change may have been the result of somewhat higher systolic BP while on placebo. Hydralazine induced minimal changes in levels of plasma catecholamines, but plasma norepinephrine levels rose in subjects on nitrendipine. Side effects encountered with both drugs were much the same, although nitrendipine was more often associated with mild fatigue. There were mild elevations in liver function parameters in two subjects on nitrendipine. There was little difference between the effects of nitrendipine and hydralazine in hypertension.