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Saucy A, Ortega N, Tonne C. Residential relocation to assess impact of changes in the living environment on cardio-respiratory health: A narrative literature review with considerations for exposome research. Environ Res 2024; 244:117890. [PMID: 38081343 DOI: 10.1016/j.envres.2023.117890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023]
Abstract
Residential relocation studies have become increasingly valuable tools for evaluating the effects of changing living environments on human health, but little is known about their application to multiple aspects of the living environment and the most appropriate methodology. This narrative review explores the utility of residential relocation as a natural experiment for studying the impact of changing urban exposures on cardio-metabolic health in high-income settings. It provides a comprehensive overview of the use of residential relocation studies, evaluates their methodological approaches, and synthesizes findings related to health behaviors and cardio-metabolic outcomes. Our search identified 43 relevant studies published between January 1995 and February 2023, from eight countries, predominantly the USA, Canada, and Australia. The majority of eligible studies were published between 2012 and 2021 and examined changes in various domains of the living environment, such as walkability, the built and social environments, but rarely combinations of exposures. Included studies displayed heterogeneity in design and outcomes, 25 involving only movers and 18 considering both movers and non-movers. To mitigate the issue of residential self-selection bias, most studies employed a "change-in-change" design and adjusted for baseline covariates but only a fraction of them accounted for time-varying confounding. Relocation causes simultaneous changes in various features of the living environment, which presents an opportunity for exposome research to establish causal relationships, using large datasets with increased statistical power and a wide range of health outcomes, behaviors and biomarkers. Residential relocation is not a random process. Thus, studies focusing on living environment characteristics need to carefully select time-varying covariates and reference group. Overall, this review informs future research by guiding choices in study design, data requirements, and statistical methodologies. Ultimately, it contributes to the advancement of the urban exposome field and enhances our understanding of the complex relationship between urban environments and human health.
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Affiliation(s)
- Apolline Saucy
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
| | - Natalia Ortega
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
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Kohon JN, Tanaka K, Himes D, Toda E, Carder PC, Carlson B. Extreme Heat Vulnerability Among Older Adults: A Multilevel Risk Index for Portland, Oregon. Gerontologist 2024; 64:gnad074. [PMID: 37330699 DOI: 10.1093/geront/gnad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Extreme heat is an environmental health equity concern disproportionately affecting low-income older adults and people of color. Exposure factors, such as living in rental housing and lack of air conditioning, and sensitivity factors, such as chronic disease and social isolation, increase mortality risk among older adults. Older persons face multiple barriers to adaptive heat mitigation, particularly those living in historically temperate climates. This study measures two heat vulnerability indices to identify areas and individuals most vulnerable to extreme heat and discusses opportunities to mitigate vulnerability among older adults. RESEARCH DESIGN AND METHODS We constructed two heat vulnerability indices for the Portland, OR, metropolitan area: one using area scale proxy measures extracted from existing regional data and another at the individual scale using survey data collected following the 2021 Pacific Northwest Heat Dome event. These indices were analyzed using principal component analysis and Geographic Information Systems. RESULTS Results indicate that the spatial distribution of areas and individuals vulnerable to extreme heat are quite different. The only area found among the most vulnerable on both indices has the largest agglomeration of age- and income-restricted rental housing in the metropolitan area. DISCUSSION AND IMPLICATIONS Due to spatial variations in heat-related risk at the individual and area scales, measures addressing heat risk should not be spatially uniform. By focusing resources on older adult individuals and areas in particular need of assistance, heat risk management policies can be both highly efficient and cost effective.
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Affiliation(s)
- Jacklyn N Kohon
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Faculty of Economics, Research Center for Sustainability and Environment, Shiga University, Hikone, Shiga, Japan
| | - Katsuya Tanaka
- Faculty of Economics, Research Center for Sustainability and Environment, Shiga University, Hikone, Shiga, Japan
| | - Dani Himes
- Institute on Aging, Portland State University, Portland, Oregon, USA
| | - Eiji Toda
- Institute on Aging, Portland State University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Paula C Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Bryant Carlson
- Institute on Aging, Portland State University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
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Choi J, Han SH, Ng YT, Muñoz E. Neighborhood Cohesion Across the Life Course and Effects on Cognitive Aging. J Gerontol B Psychol Sci Soc Sci 2023; 78:1765-1774. [PMID: 37350749 PMCID: PMC10561885 DOI: 10.1093/geronb/gbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Greater neighborhood cohesion is associated with better cognitive function in adulthood and may serve as a protective factor against cognitive impairment and decline. We build on prior work by examining the effects of perceived neighborhood cohesion across the life course on level and change in cognitive function in adulthood. METHODS Utilizing longitudinal data from the Health and Retirement Study (1998-2016) and its Life History Mail Survey, we leveraged data from 3,599 study participants (baseline age: 51-89) who participated in up to 10 waves. Respondents provided retrospective ratings of neighborhood cohesion at childhood (age 10), young adulthood (age at the first full-time job), early midlife (age 40), and concurrently at baseline (i.e., late midlife/adulthood); they completed the modified version of the Telephone Interview for Cognitive Status. We fit a univariate latent growth curve model of change in cognitive function across waves and tested whether neighborhood cohesion during each recollected life stage predicted level and change in cognitive function. RESULTS Greater neighborhood cohesion during childhood and late midlife/adulthood each predicted higher cognitive function at baseline but not the rate of cognitive decline. The final model showed that greater neighborhood cohesion in childhood and in late midlife/adulthood remained significantly associated with higher baseline cognitive function, even after accounting for one another. DISCUSSION Findings provide insight into life-course neighborhood contextual influences on cognitive aging. Our results emphasize the need for more research to understand the life-course dynamics between neighborhood environments and cognitive aging.
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Affiliation(s)
- Jean Choi
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Sae Hwang Han
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Yee To Ng
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
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Chan OF, Liu Y, Guo Y, Lu S, Chui CHK, Ho HC, Song Y, Cheng W, Chiu RLH, Webster C, Lum TYS. Neighborhood built environments and cognition in later life. Aging Ment Health 2023; 27:466-474. [PMID: 35285762 DOI: 10.1080/13607863.2022.2046697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.
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Affiliation(s)
- On Fung Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Yuqi Liu
- Department of Urban Planning, South China University of Technology, Guangzhou, China
| | - Yingqi Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Shiyu Lu
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong
| | - Cheryl Hiu Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | - Yimeng Song
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Cheng
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | | | - Chris Webster
- Healthy High Density Cities Lab, The University of Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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DePaul VG, Parniak S, Nguyen P, Hand C, Letts L, McGrath C, Richardson J, Rudman D, Bayoumi I, Cooper H, Tranmer J, Donnelly C. Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication. BMC Geriatr 2022; 22:355. [PMID: 35459126 PMCID: PMC9028895 DOI: 10.1186/s12877-022-03045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada. Methods Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming. Results Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%). Conclusions The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.
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Affiliation(s)
- Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada. .,Health Services and Policy Research Institute, Queen's University, Kingston, Canada.
| | - Simone Parniak
- Health Services and Policy Research Institute, Queen's University, Kingston, Canada
| | - Paul Nguyen
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Carri Hand
- School of Occupational Therapy, Western University, London, Canada
| | - Lori Letts
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Colleen McGrath
- School of Occupational Therapy, Western University, London, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Debbie Rudman
- School of Occupational Therapy, Western University, London, Canada
| | - Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Helen Cooper
- Oasis Senior Supportive Living Inc, Kingston, Canada
| | - Joan Tranmer
- Health Services and Policy Research Institute, Queen's University, Kingston, Canada.,Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada.,School of Nursing, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Health Services and Policy Research Institute, Queen's University, Kingston, Canada
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Jenkins Morales M, Robert SA. Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries. J Gerontol B Psychol Sci Soc Sci 2021; 75:1972-1982. [PMID: 31665513 DOI: 10.1093/geronb/gbz141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.
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Lu S, Liu Y, Guo Y, Ho HC, Song Y, Cheng W, Chui C, Chan OF, Webster C, Chiu RLH, Lum TYS. Neighborhood built environment and late-life depression: A multilevel path analysis in a Chinese society. J Gerontol B Psychol Sci Soc Sci 2021; 76:2143-2154. [PMID: 33674824 DOI: 10.1093/geronb/gbab037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical, social activities (PA & SA) and functional ability (FA) in the relationships between BEs and late-life depression. METHOD We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and above in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-meter buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas (DCCAs), urban greenness, land use diversity, and neighborhood facilities within 200- and 500-meter buffers. Multilevel path analysis models were used. RESULTS More urban greenness within both buffers and more commercial facilities within a 500-meter buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-meter buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-meter buffer, which were mediated by FA. CONCLUSION Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed.
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Affiliation(s)
- Shiyu Lu
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Yuqi Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Yingqi Guo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Yimeng Song
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Wei Cheng
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Cheryl Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - On Fung Chan
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Chris Webster
- Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Rebecca Lai Har Chiu
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Terry Y S Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Höppner G, Richter AS. [Remapping age(ing) : Additional value of an affect-based and inequality-sensitive determination of the relationship between space and age(ing)]. Z Gerontol Geriatr 2020; 53:395-400. [PMID: 32548780 DOI: 10.1007/s00391-020-01743-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The study of housing and living spaces has always played a central role in sociogerontological research. For example, living environments are seen as essential influencing factors on the quality of life and personal well-being (or the lack of it) of older people. The study of the relationship between space and age(ing) is dominated by psychologically influenced environmental gerontological approaches and social area-oriented research. While environmental perspectives in gerontology focus in particular on perceptions, experiences and affects to identify the relationships between space and age(ing), social area-oriented research tends to focus on social inequalities and strategies of participation. OBJECTIVE The results of ecogerontological approaches to affects and social area-oriented research on social inequalities are combined by means of a praxiological approach. A relational understanding of space and age is developed, which is able to focus on affects and is also sensitive to spatial exclusions based on social inequalities and which also have an affective component. This combination enables new insights into a gerontological designation of the relationship between space and age(ing). RESULTS AND CONCLUSION Such a remapping of age(ing) makes it possible to formulate other research questions regarding constructions of space through age or age through space and to provide impulses for gerontological research perspectives that take the complex interplay of humans, artefacts and spatial arrangements into account and explore the consequences for individual persons and also for their living spaces.
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Affiliation(s)
- Grit Höppner
- Fachbereich Sozialwesen, Katholische Hochschule NRW, Piusallee 89, 48147, Münster, Deutschland.
| | - Anna Sarah Richter
- Deutscher Verein für öffentliche und private Fürsorge e. V., Michaelkirchstr. 17/18, 10179, Berlin, Deutschland.
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Ang S, Chen TY. Going Online to Stay Connected: Online Social Participation Buffers the Relationship Between Pain and Depression. J Gerontol B Psychol Sci Soc Sci 2019; 74:1020-1031. [PMID: 30260444 DOI: 10.1093/geronb/gby109] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Maintaining offline social participation (i.e., face-to-face social interaction) is key for healthy aging, but older adults who experience pain tend to restrict their social activity outside of the home. The onset of pain may set off a downward spiral where lowered social participation increases the risk of depression and vice versa. This study thus assesses whether online social participation (i.e., the use of online social network sites) moderates the effect of pain on depression, possibly functioning as a compensatory mechanism for reduced offline social participation for those in pain. METHOD Logistic regression models with a lagged dependent variable were used with panel data from the National Health and Aging Trends Study. An interaction term was included to assess the moderating effect of online social participation. RESULTS We find that online social participation buffers the detrimental effect of pain on depression. However, the effect of pain on online social participation was not statistically significant. DISCUSSION Findings show that online social participation can alleviate the negative effects of pain on mental well-being, and suggest that online social participation can supplement attempts to maintain offline social participation in later life, especially for those whose social activity may be limited by pain.
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Affiliation(s)
- Shannon Ang
- Department of Sociology, University of Michigan, Ann Arbor.,Department of Population Studies Center, University of Michigan, Ann Arbor.,Department of School of Social Sciences, Nanyang Technological University, Singapore
| | - Tuo-Yu Chen
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore.,Center for Healthy Aging, Pennsylvania State University, University Park
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Stewart L, Oates J, O'Halloran P. "My Voice Is My Identity": The Role of Voice for Trans Women's Participation in Sport. J Voice 2018; 34:78-87. [PMID: 30055980 DOI: 10.1016/j.jvoice.2018.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study explored trans women's experience and awareness of their vocal communication and voice use within sporting environments. STUDY DESIGN Mixed methods study. METHODS Twenty trans women were interviewed about their voice use and vocal communication during sport and its impact on their level of participation. The participants also completed the Transsexual Voice Questionnaire for Male-to-Female Transsexuals. RESULTS Three core themes emerged from analysis of the interview data. These were: importance of voice in a sport setting, voice production in sporting environments, and psychosocial moderators of voice within the sporting environment. Trans women perceived their voices to be the main barrier to their participation in sport. These women reported that the strong gendered environment of sport made them anxious that they would not be identified as women because their voice was not always congruent with their physical appearance. However, maintaining feminine voice was deemed less critical if participants felt comfortable at their sporting club and had strong relationships with their teammates and coaches. Findings from the Transsexual Voice Questionnaire for Male-to-Female Transsexuals supported the interview data as to the impact that voice has in the lives of trans women. CONCLUSION Voice is critical for trans women who wish to integrate and be accepted as women in sporting environments. Participants suggested that voice training should target achieving a gender congruent voice and include minimalizing perceived barriers such as vocal fatigue and maintaining adequate breath support.
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