Ain't nobody got time for dad? Racial-ethnic disproportionalities in child welfare casework practice with nonresident fathers

BACKGROUND

Given fathers' potential role in bringing about desired child welfare case outcomes, researchers have begun to identify factors that impact agency efforts to identify and involve fathers. Racial-ethnic inequality and bias are not among factors studied, despite longstanding evidence that racial-ethnic minority children make up a disproportionate share of the child welfare population.

OBJECTIVE

We set out to identify racial-ethnic patterns in initial casework activity with nonresident fathers and explore whether select factors explain racial-ethnic differentials.

PARTICIPANTS AND SETTING

Caseworkers of 1,754 children in foster care in four U.S. states were surveyed.

METHODS

Bivariate and multivariate logistic regression models were used to identify factors associated with whether agencies identified, located, and contacted nonresident fathers.

RESULTS

Agencies were less likely to identify nonresident fathers of Black, Latinx, and Multiracial children, relative to those of White children. Among fathers whom agencies identified, Black and Latinx fathers were less likely to be located. Among fathers whom agencies located, Black and Latinx fathers were less likely to be contacted. Whereas greater rates of international mobility among Latinx fathers explained agencies' disproportionately low rates of contact, no other factor explained racial-ethnic differentials.

CONCLUSION

We find evidence of historical racial-ethnic disproportionalities across the three initial stages of casework practice with nonresident fathers in U.S. child welfare systems. Though more recent data are needed, this research suggests that racial-ethnic minority foster children are more likely than White foster children to be denied the benefits of agency-father contact, whether due to societal or systemic racial inequalities.

Race and Residence Variation in Living Arrangements among Unmarried Older Adults

This study examines race and residence differences in the likelihood of unmarried older persons living alone. Using data collected from a stratified, random sample of elderly persons conducted in both rural and urban areas of north Florida (N = 1,200), the investigation demonstrates that among the unmarried (n = 704), African Americans and residents of urban areas are more likely to live with others than are Whites and rural residents, respectively. This study also finds that the effects of race and residence on living alone are additive. Other factors found to significantly influence living arrangements are age, gender, the occurrence of a hospitalization in the past year, and the number of unmarried children. Variation in two additional aspects of the living arrangements of unmarried elders-the proximity of children and the relationship between elders and other members of the household-offer insight into the race and residence differences in living alone that remain unexplained by the multivariate analysis.

Race and Residence Differences in the Use of Formal Services by Older Adults

Using a longitudinal panel that oversampled older (65+) African Americans and rural residents of north Florida, this study examines race and residence differences in the use of four services: two community-based services (senior centers and special transportation) and two home-based services (homemaker and nursing care). Significant differences across race and residence groups in the use of these services were identified. Black elders, especially rural Blacks, had higher odds of using community-based services, net of other sociodemographic, social support, and health characteristics. In contrast, rural elders were most likely to use homemaker services, controlling for other factors including race. Neither race nor residence was a significant predictor of the use of in-home nursing services in this sample. The findings are discussed within the context of the importance of examining both the individual and combined influences of race and residence on formal service use.

Race Comparisons of the Household Dynamics of Older Adults

Longitudinal studies have suggested that households are much more fluid than was once believed. Yet our understanding of changes in household composition is based on limited sets of transitions occurring across relatively long intervals. Furthermore, we know relatively little about ethnoracial variation in household dynamics. Using data from a sample of older Floridians, the authors describe race differences in longitudinal patterns of household change that occurred during four 6-month intervals. Approximately one quarter of respondents experienced some change in composition during the 24-month study. Older African Americans lived in larger and more dynamic households and were more likely to form coresident relationships with grandchildren and nonrelatives. Age, gender, marital status, and disability were also associated with the likelihood of acquiring a new household member. Findings from this research provide additional insight into the processes through which race differences in the composition of households emerge and are maintained over time.

Race, Aging, and Care

There are substantial uncertainties about key dimensions of the caregiving process as it is experienced by older adults from different racial groups. This investigation explores the care received from family members among a stratified random sample of community-dwelling older (65+) African Americans and Whites who reported difficulties performing daily living tasks. Findings support past research indicating that older African Americans are more likely to receive help from family members than are Whites when in need of assistance. However, this advantage does not extend across all types of family members but, rather, is only statistically significant in the final models with regard to the care received from grandchildren. Evidence is presented that indicates that the observed race differences in the receipt of care from children can be attributed to variations between racial groups in family and household structure. The findings suggest that coresidence may be a form of family caregiving among older African Americans.

The Changing Caregiving Networks of Older Adults

One of the dominant features of caregiving networks, their propensity to change over time, continues to be incompletely described and inadequately understood. The purpose of this study is to illuminate the complex patterns of change that shape the evolving caregiving networks of older adults. Using data from the Longitudinal Study of Aging (LSOA), a transition matrix approach is used to describe the changes older adults experience in their caregiving arrangements over time. These caregiving networks are characterized by both stability and change. At any given time, most elders are able to live independently without the help of a caregiver. The caregiving network, once activated, appears to be characterized by a great deal of change in care configurations. Finally, beyond a certain threshold off frailty, extensive care is required in either a community or an institutional setting. Variation in transitions by age, gender, race, and place of residence are examined.

Death by mental retardation? The influence of ambiguity on death certificate coding error for adults with intellectual disability

BACKGROUND

Although the coding of mental retardation as underlying cause of death has been recognised by previous researchers as erroneous, factors influencing this inaccuracy have not been sufficiently analysed. This study explores the effects of diagnostic ambiguity on risk of mental retardation being coded as underlying cause of death on US death certificates from 2004.

METHODS

Utilising all US death certificates from 2004 that included a cause of death code for mental retardation, logistic regression analysis provided estimates of the likelihood of having mental retardation erroneously coded as the underlying cause of death. Estimators used to measure ambiguity included the number of multiple causes of death, the place of death, and ICD-10 diagnostic Chapter codes.

RESULTS

A total of 2278 US death certificates from 2004 included a cause of death code for mental retardation. Of these death certificates, 20% erroneously coded mental retardation as the underlying cause of death. Reflecting the negative impact of diagnostic ambiguity on death certificate coding accuracy, mental retardation was more likely to be coded as underlying cause of death for decedents who: (1) had a death certificate that provided less information on co-morbid disease processes; (2) died in an outpatient or emergency room setting; or (3) had either abnormal symptomatology or death by injury, accident or other external cause.

CONCLUSIONS

Findings from this study, as well as prior research, demonstrate that attempts to understand mortality trends for this population must attend to frequent underlying cause of death coding errors which threaten accuracy of cause of death data. Furthermore, inquiry is warranted into the impetus behind US death certificate coding policy that continues to allow the erroneous coding of 'death by mental retardation'.

Self-rated health and morbidity onset among late midlife U.S. adults

OBJECTIVES

Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years).

METHOD

Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770).

RESULTS

SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke.

DISCUSSION

This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

A longitudinal analysis of sociodemographic and health correlates of sexual health among HIV-infected men in the USA

BACKGROUND

Sexual health among HIV-infected men primarily has been examined in cross-sectional designs. Few have used longitudinal data to measure sexual health change or factors associated with change. Moreover, studies of HIV-infected men disproportionately focus on sexual risk behaviours. The present paper examines temporal changes in sexual health based on measures of sexual activity, erectile function, sex drive, and sex life satisfaction.

METHODS

Data from a prospective cohort study of HIV-infected men (n = 197) in the USA were used. Sexual health measures were based on self-reported sexual activity, erectile function, sex drive, and sex life satisfaction at 12- and 24-month follow-ups. Transition matrices described 1-year sexual health changes. Logistic regression models determined sociodemographic and health-related factors associated with change.

RESULTS

Men reported considerable change in sexual health during the year-long observation interval. Among men who experienced change, younger age, cohabitation, and higher CD4 counts were associated with greater sexual activity over time. Men with more depression symptoms had lower erectile function over time, and higher education and higher income were protective against temporal declines in sex drive and satisfaction. Less disease comorbidity was associated with 1-year improvements in sex life satisfaction.

CONCLUSIONS

Some men in our sample experienced sexual health change, but stability was common for most. Temporal changes in sexual health varied according to age, cohabitation, education, income, and physical and mental health covariates. The present paper highlights the benefits of longitudinal investigations and multidimensional definitions of sexual health.

The dynamics of toothache pain and dental services utilization: 24-month incidence

OBJECTIVES

The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa.

METHODS

Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months.

RESULTS

At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders.

CONCLUSIONS

In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.

Predictors of chewing difficulty onset among dentate adults: 24-month incidence

OBJECTIVES

Chewing ability is an important measure of health-related quality of life, yet few studies have examined predictors of chewing difficulty in community-based samples. This study describes longitudinal patterns of chewing difficulty and identifies predictors of chewing difficulty onset.

METHODS

The Florida Dental Care Study (FDCS) was a longitudinal study of oral health and related behaviors. Interviews and a clinical exam were conducted with a sample that included persons who had at least one tooth and were aged 45 years or older (n = 873). The five-item chewing index of Leake (1990), with minor revision, was the outcome of interest.

RESULTS

Approximately 21 percent of baseline participants reported chewing difficulty and about 34 percent reported difficulty during the study. Having infected or sore gums, loose tooth, loose crown or bridge, toothache pain, lower numbers of opposing pairs of teeth, dry mouth, and being female were significant predictors of incident chewing difficulty.

CONCLUSIONS

Self-reported oral disease and tissue damage and toothache pain were strong predictors of decline in chewing ability. Additionally, women were identified as a high-risk group for incident chewing difficulty. Future research should elaborate further the pathways through which these factors affect oral function.

Correlation of admission criteria with dental school performance and attrition

This study was conducted to provide current information on the relationship between admission criteria and dental school performance, including the association of admission criteria and dental school outcomes such as remediation and attrition. Standard tests of bivariate association and multivariate regression models appropriate for continuous and discrete dependent variables were used to examine the relationship between multiple indicators of admission criteria and dental school performance for six recent classes at the University of Florida College of Dentistry (UFCD). The admission criteria included the undergraduate science grade point average (GPA), undergraduate non-science GPA, Dental Admissions Test (DAT) academic score, Perceptual Motor Aptitude Test (PMAT) score, and admission interview score. Measures of dental school performance were the National Dental Board Examination Part I and Part II (NB-I, NB-II) scores, yearly and final dental school GPA, and academic progress through the UFCD program. In general, most admission criteria were good bivariate indicators of dental school performance. Multivariate analyses indicated that students with higher undergraduate science GPAs and DAT academic scores were more likely to achieve higher NB-I and NB-II scores. The undergraduate science GPA and admission interview score were the most consistent determinants of dental school GPA. Students with lower undergraduate science GPAs, DAT academic scores, and PMAT scores were more likely to remediate, to repeat an academic year, or to be dismissed. Although bivariate differences were observed in several admission criteria of students who remediated one or more courses, repeated an academic year, or were dismissed only the undergraduate science GPA and the PMAT score were indicators of programmatic progress in the multivariate analysis.

Race and ethnic variation in the disablement process

OBJECTIVES

This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS

Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS

Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION

The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

Patterns of change in self-reported oral health among dentate adults

BACKGROUND

Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time.

METHODS

The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period.

RESULTS

The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery.

CONCLUSION

Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

Functional health and dental service use among older adults

BACKGROUND

Although socioeconomic barriers to receiving adequate dental care have been well documented, physical frailty as a risk factor for not visiting the dentist has not been fully explored. This study prospectively examines the relationship between functional health and dental service use, taking into account sociodemographic characteristics, general and dental health status, and prior dental utilization behavior.

METHODS

Data from a randomized trial of a comprehensive geriatric assessment and prevention program in community-dwelling adults age 75+ years living in Santa Monica, CA, collected between 1988 and 1993, were analyzed. A series of discrete-time proportional hazards models were used to assess the effects of functional status, sociodemographic characteristics, and general health and dental health measures on dental service use.

RESULTS

Functional status was negatively associated with dental service use, and the conditional probability of a first visit to the dentist after baseline decreased over time. When additional measures of general health, dental health, and socioeconomic status were introduced, the effect of functional status was mitigated but remained significant. In the most fully specified model, which took dental visitation behavior prior to the beginning of the study into account, the effect of functional limitation remained significant.

CONCLUSIONS

Even in this relatively well-educated group of older persons with higher than average dental service use, impaired functional status was associated with lower levels of dental service use over time.

Are expectations for care related to the receipt of care? An analysis of parent care among disabled elders

This investigation explores the relationship between the degree to which older parents expect assistance from their children and the actual amount of care they receive from their children. Combining the theories of reasoned action and intergenerational solidarity, we hypothesize that global expectations (social norms about receiving care) influence specific expectations (behavioral intentions to seek care), but that it is specific expectations that influence the amount of care received from children. Data were collected at three points over a 12-month period among a sample of impaired older parents (65+) who lived independently in community settings (n = 334). Using structural equation models, the results were consistent with the hypothesis. We conclude that the theory of reasoned action is a useful adjunct to the theory of intergenerational solidarity by proposing that parents adjust their global expectations to reflect the specific realities of the lives of their children.

Three-year changes in global oral health rating by elderly dentate adults

The single item global rating is an economical way of summarizing the state of a person's oral health, and thus is a potentially valuable oral health outcome measure. This research describes the nature, magnitude, and direction of changes in oral health as measured by the global rating with the goal of furthering our understanding of older adults' oral health perceptions over time. Data from a randomized trial of a comprehensive geriatric assessment and prevention program in community-dwelling adults aged 75+ years living in Santa Monica, California, collected between 1988 and 1993 were analyzed. Descriptive techniques as well as a transition matrix were used to examine changes in the global rating and compare these changes to variation, over time, in two relevant measures: the Geriatric Oral Health Assessment Index (GOHAI) and self-reported need for dental treatment. The global rating varied over time and the changes were consistent with those measured by the GOHAI and self-reported treatment need. Whether the change in oral health as measured by the global rating is clinically meaningful, and what specific dental conditions account for these changes remain important topics for future investigation. However, the changes that occur in oral health ratings at the individual level are much more pronounced than the distribution of global rating at each point in time would suggest.

Differences by race in the decline of health over time

Previous research on race differences in health, we believe, has failed to take into account the initial state of health of the respondents. Other research has demonstrated that elders in poor health are more likely to experience a change in their health over time. It is unclear if the greater probability of decline in health observed among African Americans is a result of being more likely to begin such observations in health states that are worse than those for Whites. This investigation examines declines in health over a 30-month period in a sample of African American and White elders who began the study in similar "good health." Findings support the supposition that African Americans are more likely to report a decline in their health, regardless of the health measure used. Differences by race in the decline of health appear to be a consequence of economic and educational discrepancies between the two groups.

The influence of community context on the preferences of older adults for entering a nursing home

Previous research has established that rural elders are more likely to enter a nursing home than elders living in suburban and urban areas. This research examined preferences for long-term care alternatives using a telephone survey of community-dwelling elders (age 65+). In contrast to admission patterns, urban elders were more likely to prefer nursing home care if unable to live independently. This difference persisted in multinomial logit models that included other predictors of nursing home use. Thus, rural elders may be more likely to experience discrepancies between their preferred mode of long-term care and the actual outcomes that they may ultimately experience.

Race differences in the health of elders who live alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Predicting nursing home admissions among incontinent older adults: a comparison of residential differences across six years

Whether or not rates of nursing home admissions among elders with urinary incontinence varied by their place of residence was investigated. We also examined whether any observed residential differences could be accounted for by factors other than incontinence that are known to influence rates of institutionalization. Data from the Longitudinal Study on Aging (1984-1990) were used to examine a sample who at baseline lived in community settings and reported problems with urinary incontinence (n = 719). Analyses indicate that residents of less urbanized and thinly populated nonmetropolitan counties were more likely to have a nursing home admission than elders in any other residential context. More importantly, these residential differences persisted in multivariate logistic regression models after controls were introduced for sociodemographic characteristics, measures of health status, and indicators of the social support networks of the elders.

Gender roles and female drinking-driving

Using roadside survey data on 2044 drivers in a southern metropolitan community, the potential of gender roles for explaining the role behavior of female drinking drivers was examined. Although female drinking drivers are like female nondrinking drivers in previous driving and drinking-driving experiences, overall they are more like male drinking drivers. Both female and male drinking drivers tend to drive in similar places and to be on the roads at similar times and days. They also carry similar numbers and types of passengers. The greater similarity of female drinking drivers to male drinking drivers than to nondrinking female drivers suggests caution in leaning too heavily on gender roles as explanations of female drinking-driving behavior.

The consequences of early marriage on marital dissolution

This study is concerned with the negative effects of early marriage on marital stability. "The focus on this paper is an analysis of a path model which includes the estimated effects of antecedents of early marriage, early marriage and education on the probability of divorce. Findings using the [U.S.] General Social Surveys support research that suggests that early marriage is the most important varialbe influencing divorce. Further, little influence of the early marriage measure through education was found."