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Martinez A, Warner A, Powe NR, Fernandez A, Tuot DS. Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD. KIDNEY360 2024; 5:560-568. [PMID: 38356152 PMCID: PMC11093550 DOI: 10.34067/kid.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Key Points In one hospital-based safety-net dialysis unit, only one half of patients with ESKD knew their cause of kidney failure, which did not differ by English proficiency status. Patients with limited English proficiency (versus English-proficient patients) reported poorer communication with the dialysis care team (less listening, fewer clear explanations, less time spent). We highlight the need for tailored, patient-centered communication between limited English-proficient patients and dialysis care team members. Background ESKD is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet, little is known about the quality of communication among patients with ESKD and their care team members. We examined the influence of patient's limited English proficiency (LEP) status on communication experiences at one dialysis center. Methods A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and sex were used to determine associations between LEP status and CKD knowledge. Results Among 93 eligible patients, 88.2% (n =82) completed the survey. Approximately 37.8% (n =31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% versus 38.7%, P = 0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (odds ratio, 0.49; 95% confidence interval, 0.19 to 1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (odds ratio, 3.99; 95% confidence interval, 1.66 to 9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared with English-proficient patients, although differences were not statistically significant. Conclusions Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.
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Affiliation(s)
- Ashley Martinez
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Austin Warner
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Neil R. Powe
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia Fernandez
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Delphine S. Tuot
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Division of Nephrology, University of California, San Francisco, San Francisco, California
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Tang F, Li K, Wang Y, Zhu Y, Jiang Y. Social Disconnectedness, Perceived Loneliness, and Cognitive Functioning: The Role of Neighborhood Environment. Innov Aging 2024; 8:igae009. [PMID: 38500713 PMCID: PMC10946307 DOI: 10.1093/geroni/igae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 03/20/2024] Open
Abstract
Background and Objectives Social disconnectedness and loneliness pose significant challenges for older Chinese immigrants. Yet, it remains unclear whether they are associated with an increased risk of cognitive decline in this population. This study aimed to investigate the association of social disconnectedness and loneliness with cognitive functioning and examine the moderation role of neighborhood contexts. Research Design and Methods This longitudinal analysis examined a sample of individuals aged 60 years and older from the Population Study of Chinese Elderly in Chicago (N = 2,044). Global cognition was assessed using the averaged z-scores of cognitive performance tests. Social disconnectedness was constructed using 5 indicators about structural aspects of social relationships. Loneliness was assessed with the R-UCLA loneliness scale. Neighborhood socioeconomic status (NSES) and neighborhood segregation index were constructed using 2010-2014 American Community Survey data at the census tract level. Individual perceptions about neighborhood environments were used to construct neighborhood cohesion index and neighborhood disorder index (NDI). Latent growth curve models with adjusted cluster robust standard errors were estimated. Results More loneliness was associated with a higher level of initial cognitive functioning (B = 0.030, p < .01), but also with a faster decline rate over time (B = -0.007, p < .01) after adjusting for covariates. High NSES and less neighborhood segregation buffered the negative effects of loneliness on cognitive decline, respectively. High NDI amplified the positive relationship between loneliness and initial functioning, but accelerated the rate of cognitive decline associated with loneliness. Discussion and Implications The study revealed that perceived loneliness, but not social disconnectedness, is a risk factor for cognitive decline among older Chinese immigrants. Living in a neighborhood with low socioeconomic status, more segregation, and high disorder elevated the detrimental effect of loneliness on long-term cognitive decline. Further research needs to investigate the complex interplay between social relationships, neighborhood environment, and cognition.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, Univeristy of Pittsburgh. Pittsburgh, Pennsylvania, USA
| | - Ke Li
- School of Social Work, Univeristy of Pittsburgh. Pittsburgh, Pennsylvania, USA
| | - Yi Wang
- School of Social Work, University of Iowa, Iowa City, Iowa, USA
| | - Yuyang Zhu
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Yanping Jiang
- Department of Family Medicine and Community Health, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Jiang Y, Zhu Y, Tang F, Chung T, Wu B. Residential Segregation, Perceived Neighborhood Environment, and All-Cause Mortality Among Community-Dwelling Older Chinese Americans. J Gerontol B Psychol Sci Soc Sci 2023; 78:2071-2079. [PMID: 37726003 PMCID: PMC10699736 DOI: 10.1093/geronb/gbad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Residential segregation profoundly affects mental and physical health. However, impacts of residential segregation and other neighborhood characteristics on health among older Asian Americans are not fully understood. This study aimed to close this gap by examining effects of residential segregation, perceived neighborhood cohesion, and neighborhood disorder on all-cause mortality among older Chinese immigrants, as well as testing whether the association between residential segregation and mortality would be mediated by perceived neighborhood cohesion and neighborhood disorder. METHODS Data were drawn from a subsample of 3,094 older Chinese Americans aged 60 and older (mean age = 72.8 years) from the Population Study of Chinese Elderly in Chicago. Residential segregation was derived using 2010-2014 American Community Survey data. Participants completed surveys on perceived neighborhood cohesion and neighborhood disorder between 2011 and 2013. All-cause mortality was tracked until December 2021. RESULTS Residential segregation was associated with elevated all-cause mortality risk; this association, however, was no longer statistically significant after controlling for sociodemographic, behavioral, and health covariates. Perceived neighborhood cohesion, but not neighborhood disorder, was significantly associated with decreased mortality risks. There were no indirect effects of residential segregation on all-cause mortality through perceived neighborhood cohesion or neighborhood disorder. These effects were consistent across male and female participants. DISCUSSION These results suggest the importance of neighborhood social environment, specifically perceptions of neighborhood cohesion, in influencing mortality risk among older Chinese immigrants. The findings also indicate the need to conduct further research to examine the health impact of residential segregation among this population.
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Affiliation(s)
- Yanping Jiang
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Family Medicine and Community Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Yuyang Zhu
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - Tammy Chung
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Psychiatry, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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Tang F, Jiang Y, Li K, Rosso AL. Residential Segregation and Depressive Symptoms in Older Chinese Immigrants: The Mediating Role of Social Processes. THE GERONTOLOGIST 2023; 63:1376-1384. [PMID: 36905359 PMCID: PMC10474590 DOI: 10.1093/geront/gnad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Older Chinese immigrants are at risk for depression due to acculturative stress and language barriers. Residential segregation with respect to language use plays an important role in the mental health of historically marginalized populations. Previous research provided mixed evidence about the segregation effect among older Latino and Asian immigrants. Guided by a model of social processes, we examined the direct and indirect effects of residential segregation on depressive symptoms via multiple mechanisms of acculturation, discrimination, social network, social support, social strain, and social engagement. RESEARCH DESIGN AND METHODS Four waves of depressive symptoms were assessed in the Population Study of Chinese Elderly (2011-19, N = 1,970), and linked to the 2010-14 American Community Survey estimates of neighborhood context. Residential segregation was measured by the Index of Concentrations at the Extremes which simultaneously assesses Chinese and English language use within a given census tract. Latent growth curve models with adjusted cluster robust standard errors were estimated after controlling for individual-level factors. RESULTS Residents of segregated Chinese-speaking neighborhoods had fewer baseline depressive symptoms but a slower rate of symptom reduction than those living in neighborhoods segregated with English-only speakers. Racial discrimination, social strain, and social engagement partially mediated the association between segregation and baseline depressive symptoms; social strain and social engagement partially mediated the association with long-term reduction in depressive symptoms. DISCUSSION AND IMPLICATIONS This study demonstrates the importance of residential segregation and social processes in shaping mental well-being among older Chinese immigrants and suggests potential mechanisms to alleviate mental health risks.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yanping Jiang
- Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Family Medicine and Community Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Ke Li
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ornelas Van Horne Y, Diaz LM, Trowbridge J, Alcala CS, González DJ. Toward Language Justice in Environmental Health Sciences in the United States: A Case for Spanish as a Language of Science. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:85001. [PMID: 37610227 PMCID: PMC10445527 DOI: 10.1289/ehp12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/22/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Increasingly, marginalized communities are disproportionately facing the worsening effects of environmental hazards, including air pollution, water pollution, and climate change. Language isolation and accessibility has been understudied as a determinant of health. Spanish, despite being the second-most common language in the United States with some 41.8 million speakers, has been neglected among environmental health scientists. Building capacity in high-quality Spanish-language science communication, both for scientific and nonscientific audiences, can yield improvements in health disparities research, public health literacy, international collaborations, and diversity and inclusion efforts. OBJECTIVES In this article, we discuss the context of language diversity in environmental health sciences and offer recommendations for improving science communication in Spanish. DISCUSSION English is currently the predominant language for scientific discourse, but Spanish and other non-English languages are routinely used by many environmental health science students and professionals, as well as much of the public. To more effectively conduct and communicate environmental health work in Spanish, we suggest that researchers and scientific institutions a) foster structural changes, b) train emerging scholars and support established researchers, c) tap into community ways of knowing, and d) leverage emerging technologies. https://doi.org/10.1289/EHP12306.
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Affiliation(s)
| | - Laura M. Diaz
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jessica Trowbridge
- Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Cecilia S. Alcala
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David J.X. González
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, Berkeley, California, USA
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Tang F, Li K, Rosso AL, Jiang Y, Li M. Neighborhood segregation, socioeconomic status, and cognitive function among older Chinese immigrants. J Am Geriatr Soc 2023; 71:916-926. [PMID: 36508718 PMCID: PMC10023380 DOI: 10.1111/jgs.18167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/16/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The fast-growing population of older Chinese immigrants and their segregated residences highlight the importance of understanding the role of neighborhood context in cognitive health. The segregation-cognition association is equivocal based on a limited number of studies among Hispanic and Asian Americans. To close the knowledge gap, this study examined the associations of neighborhood segregation and socioeconomic status (NSES) with cognitive functioning among older Chinese immigrants. METHODS Four waves of cognitive performance tests were conducted in the Population Study of Chinese Elderly in Chicago (2011-2019) and linked to the 2010 to 2014 American Community Survey estimates of neighborhood contexts. NSES was a summary z-score of six census variables of education, income/wealth, and occupation. Neighborhood segregation was measured by the Index of Concentrations at the Extremes (ICE), which simultaneously assesses Chinese and English language use within a given census tract. There were 170 census tracts in the present sample of 2044 participants. Latent growth curve models with adjusted cluster robust standard errors were estimated. RESULTS On average, cognitive functioning declined over time (B = -0.07, p < 0.001). After adjusting for individual-level predictors, living in high-NSES neighborhoods was associated with slower cognitive decline (B = 0.003, p = 0.04). ICE was not associated with cognitive functioning, but boosted the protective effect of high NSES on cognitive decline (B = 0.006, p = 0.05). CONCLUSIONS Neighborhood socioeconomic advantage was related to slower cognitive decline among older Chinese immigrants, especially among those living in neighborhoods with more English speakers or less segregation. This finding suggests complex associations between neighborhood context and cognitive health among Chinese immigrants.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, PA
| | - Ke Li
- School of Social Work, University of Pittsburgh, Pittsburgh, PA
| | - Andrea L Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Yanping Jiang
- Rutgers University, The State University of New Jersey, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ
| | - Mengting Li
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
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Gutiérrez Á, Bravo RL, Tobin CT. Loneliness Exacerbates the Association Between Bodily Pain and Depressive Symptoms Among Middle-Aged and Older Latinx Adults. J Aging Health 2022; 34:1201-1212. [PMID: 36154318 DOI: 10.1177/08982643221127327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To investigate the associations between three bodily pain dimensions (intensity, frequency, severity) and depressive symptoms among middle-aged and older Latinxs ages 40-94 and to determine whether loneliness conditioned the pain-depressive symptoms associations. Methods: Data are from a community-based study of community-dwelling residents in Florida (N = 527). Multivariable linear regression models assessed the impact of each pain dimension on depressive symptoms, controlling for sociodemographic factors. Interactions determined whether loneliness moderated the pain-depressive symptoms relationships. Results: Each pain dimension was positively associated with depressive symptoms (p < .01). Loneliness modified the impact of pain frequency and pain severity on depressive symptoms. Those with moderate and high loneliness levels experienced an amplified pain-depressive symptoms association. Discussion: Findings underscore the synergistic effects of pain and loneliness in exacerbating depressive symptomatology among middle-aged and older Latinx adults. Loneliness is an important point of intervention to improve mental health among aging Latinxs.
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Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, 1354Ohio University, Athens, OH, USA
| | - Rosana L Bravo
- Department of Health Sciences Education, College of Health Sciences, 6645Western University of Health Sciences, Pomona, CA, USA
| | - Courtney Thomas Tobin
- Department of Community Health Sciences, Fielding School of Public Health, 25808University of California, Los Angeles, CA, USA
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8
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Studying segregation in Estonia using call data records. SOCIAL NETWORK ANALYSIS AND MINING 2021. [DOI: 10.1007/s13278-021-00817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Faraji J, Metz GAS. Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why? Aging Dis 2021; 12:1624-1643. [PMID: 34631211 PMCID: PMC8460299 DOI: 10.14336/ad.2021.0319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.
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Affiliation(s)
- Jamshid Faraji
- 1Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada.,2Faculty of Nursing & Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gerlinde A S Metz
- 1Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
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Zhang D, Rajbhandari-Thapa J, Panda S, Chen Z, Shi L, Li Y, Shen Y, Ghimire R, Emerson KG. Linguistic Isolation and Mortality in Older Mexican Americans: Findings from the Hispanic Established Populations Epidemiologic Studies of the Elderly. Health Equity 2021; 5:375-381. [PMID: 34095708 PMCID: PMC8175265 DOI: 10.1089/heq.2020.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Limited English proficiency and increased language isolation are known to be associated with adverse health outcomes. It is not clear how neighborhood-level linguistic isolation may impact individual health and risk of death among Hispanic older adults. We examined the link between living in a linguistically isolated neighborhood and all-cause mortality among an older Mexican American cohort. Methods: Using a longitudinal sample of older Mexican Americans from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly, we calculated the days from the baseline interview (1993–1994) until observed death through five waves of follow-up (until 2004–2005) using Cox regression. A linguistically isolated neighborhood was defined as a census tract with more than 30% of linguistically isolated households. Results: Our results showed that living in a neighborhood with more than 30% of linguistically isolated households predicted higher mortality (hazard ratio: 1.25; 95% confidence interval: 1.04–1.50), after adjusting for age, sex, nativity, years of education, marital status, self-reported health status, number of chronic conditions, ever smoked, ever drank, and other neighborhood-level contextual factors. Conclusion: Living in a neighborhood with a high proportion of linguistically isolated households predicted higher mortality among older Mexican Americans. Addressing the social capital shortage in linguistically isolated neighborhoods is one way to address health disparities in the United States.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Saswat Panda
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Yan Li
- Department of Population Health Science and Policy, Gynecology, and Reproductive Science (Secondary), Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology, and Reproductive Science (Secondary), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | | | - Kerstin Gerst Emerson
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
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Bishop-Royse J, Lange-Maia B, Murray L, Shah RC, DeMaio F. Structural racism, socio-economic marginalization, and infant mortality. Public Health 2020; 190:55-61. [PMID: 33348089 DOI: 10.1016/j.puhe.2020.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We examine associations between infant mortality rates (IMRs) and measures of structural racism and socio-economic marginalization in Chicago, Illinois. Our purpose was to determine whether the Index of Concentration at the Extremes (ICE) was significantly related to community-level IMRs. STUDY DESIGN We use a cross-sectional ecological public health design to examine community-level factors related to IMRs in Chicago neighborhoods. METHODS We use data from the Chicago Department of Public Health and the American Community Survey to examine IMR inequities during the period 2012-2016. Calculations of the ICE for race and income were undertaken. In addition, we calculated racialized socio-economic status, which is the concentration of affluent Whites relative to poor Blacks in a community area. We present these ICE measures, as well as hardship, percent of births with inadequate prenatal care (PNC), and the percent of single-parent households as quintiles so that we can compare neighborhoods with the most disadvantage with neighborhoods with the least. Negative binomial regression was used to determine whether the ICE measures were independently related to community IMRs, net of hardship scores, PNC, and single-parent households. RESULTS Spearman correlation results indicate significant associations in Chicago communities between measures of racial segregation and economic marginalization and IMRs. Community areas with the lowest ICERace scores (those with the largest concentrations of Black residents, compared with White) had IMRs that were 3.63 times higher than those communities with the largest concentrations of White residents. Most associations between community IMRS and measures of structural racism and socioeconomic marginalization are accounted for in fully adjusted negative binomial regression models. Only ICERace remained significantly related to IMRs. CONCLUSIONS We show that structural racism as represented by the ICE is independently related to IMRs in Chicago; community areas with the largest concentrations of Blacks residents compared with Whites are those with the highest IMRs. This relationship persists even after controlling for socio-economic marginalization, hardship, household composition/family support, and healthcare access. Interventions to improve birth outcomes must address structural determinants of health inequities.
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Affiliation(s)
- J Bishop-Royse
- Faculty Scholarship Collaborative, DePaul University, Chicago, IL 60614, USA; Center for Community Health Equity, Chicago, IL, USA.
| | - B Lange-Maia
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL 60612, USA; Center for Community Health Equity, Chicago, IL, USA.
| | - L Murray
- Center for Community Health Equity, Chicago, IL, USA.
| | - R C Shah
- Center for Community Health Equity, Chicago, IL, USA; Department of Family Medicine, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
| | - F DeMaio
- Center for Community Health Equity, Chicago, IL, USA; Center for Health Equity, American Medical Association, Chicago, IL 60611, USA; Department of Sociology, DePaul University, Chicago, IL 60614, USA.
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12
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Xie Y, Ma M, Wu W, Zhang Y, Zhang Y, Tan X. Dose-response relationship between intergenerational contact frequency and depressive symptoms amongst elderly Chinese parents: a cross-sectional study. BMC Geriatr 2020; 20:349. [PMID: 32933472 PMCID: PMC7490477 DOI: 10.1186/s12877-020-01751-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Given the high prevalence of depressive symptoms amongst the elderly Chinese population and the significance of intergenerational contact in this demographic group, the purpose of this study was to examine the association and dose–response relationship between the frequency of intergenerational contact and depressive symptoms. Methods Data were obtained from the third wave of the China Health and Retirement Longitudinal Study. A total of 5791 participants at age 60 or older were included in this study. Depressive symptoms were defined by the 10-item version of the Centre for Epidemiologic Studies Depression Scale. Intergenerational contact included in-person meeting and remote connecting, and they were analysed separately. Intergenerational contact frequency was classified into ten categories and then treated as a continuous variable for analysis. We performed univariate and multivariate logistic regressions to identify risk covariables. Restrictive cubic spline analysis was used to examine the dose–response relationship between intergenerational contact frequency and the outcome of depressive symptoms. Results Both the frequency of meeting and the frequency of connecting with children were independently associated with depressive symptoms in the elderly, and the odds ratios for depressive symptoms increased with decreasing frequencies (P < 0.01). There was a negative dose–response relationship between intergenerational contact frequency and depressive symptoms. The odds of depressive symptoms steadily decreased with increasing frequency of meeting with their children. Following an initial increase, the odds rapidly decreased as the frequency of connecting with children increased with an inflection point at once a monthly. Both associations were nonlinear (P < 0.001). Conclusions Our findings revealed a negative dose–response relationship between intergenerational contact frequency and depressive symptoms in the elderly Chinese population. Thus, future health interventions should consider cultural norms in shaping the mental well-being of Chinese elderly persons.
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Affiliation(s)
- Yaofei Xie
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Mengdi Ma
- Wuhan Blood Center, No.8 of Baofeng One Road, Wuhan, 430000, China
| | - Wenwen Wu
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Yupeng Zhang
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Yuting Zhang
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Xiaodong Tan
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China.
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Mendez SEA, Mendez-Luck CA, Nylund-Gibson K, Ng B. Mental Health Attribution for Mexican-Origin Latinx and Non-Latinx Older Adults: A Latent Class Analysis. Innov Aging 2020; 4:igaa028. [PMID: 34136663 PMCID: PMC8202504 DOI: 10.1093/geroni/igaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing appropriate and culturally sensitive care to the rapidly growing number of
U.S. Latinx older adults with psychiatric conditions presents a major public health
challenge. We know little about older Latinx adults’ perceived causes of mental health
problems, offering clinicians limited insight to guide successful and culturally
congruent treatment. Moreover, there is a paucity of mental health research examining
heterogeneity in how Latinx individuals may attribute mental health symptoms. The
present study sought to identify how Latinx and non-Latinx older adults attributed the
sources of their mental health problems and how these types of attributions differ by
ethnicity. Research Design and Methods This study analyzed data collected from a retrospective chart review and survey of 673
adults aged 55–95 years (430 Mexican origin and 244 non-Latinx) from a rural psychiatric
outpatient clinic near the California–Mexico border. We conducted stratified latent
class analysis (LCA) by race/ethnicity to explore the mental health attribution beliefs
of Mexican-origin and non-Latinx clinic patients. Results Different LCA patterns for Mexican-origin Latinx versus non-Latinx groups were found.
For non-Latinx adults, there was a class of individuals who attributed their mental
health issues to social and financial problems. For Mexican-origin adults, there was a
class of individuals who attributed their mental health issues to spiritual and/or
supernatural factors, unaffected by acculturation level, depressive symptom severity,
and time spent in the United States, but differing by gender. We found within-group
heterogeneity: Not all Mexican-origin or non-Latinx older adults were alike in how they
conceptualized their mental health. Discussion and Implications Mexican-origin Latinx and non-Latinx older adults attributed their mental health issues
to different causes. More Mexican-origin older adults attributed their symptoms to
spiritual causes, even after controlling for contextual factors. Further research is
needed to determine whether attribution beliefs are affected by specific mental health
diagnoses and other cultural factors not measured in this study.
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Affiliation(s)
- Stephanie E A Mendez
- University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles
| | | | | | - Bernardo Ng
- Sun Valley Behavioral Research Center, Imperial, California
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Nguyen H, Lee JA, Sorkin DH, Gibbs L. "Living happily despite having an illness": Perceptions of healthy aging among Korean American, Vietnamese American, and Latino older adults. Appl Nurs Res 2019; 48:30-36. [PMID: 31266605 DOI: 10.1016/j.apnr.2019.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/29/2019] [Accepted: 04/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE The growingly diverse aging population presents a challenge for the geriatric workforce, particularly its capacity to effectively respond to the sociocultural and linguistic needs of ethnic minority older adults. Informed by research on the importance of culturally-competent care in reducing racial and ethnic health disparities, this study sought to understand the meaning of healthy aging from the perspectives of Korean American, Vietnamese American, and Latino older adults. METHODS Interviews were conducted with 30 participants recruited from community-based organizations in Southern California. RESULTS Several dimensions emerged in the participants' understanding of healthy aging: (1) having good physical and mental health (2) optimism and acceptance; (3) social connectedness; (4) taking charge of one's health; and (5) independence and self-worth. CONCLUSIONS Results could inform the development of a culturally-responsive geriatric healthcare system that takes into account older adults' beliefs, preferences, and needs to promote successful aging.
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Affiliation(s)
- Hannah Nguyen
- California State University, Dominguez Hills, Department of Human Services, 1000 East Victoria Street, Carson, CA 90747, United States of America.
| | - Jung-Ah Lee
- University of California, Irvine, Sue & Bill Gross School of Nursing, 100A Berk Hall, Irvine, CA 92697-3959, United States of America.
| | - Dara H Sorkin
- University of California, Irvine, Department of Medicine, School of Medicine, 100 Theory, Suite 120, Irvine, CA 92697, United States of America.
| | - Lisa Gibbs
- University of California, Irvine, Division of Geriatric Medicine & Gerontology, Department of Family Medicine, School of Medicine, 200 Manchester, Suite 835, Orange, CA 92865, United States of America.
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