Chi Chiao

Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan

BackgroundRelatively little empirical attention has focused on the association between social participation and depressive symptoms amongst older adults in Asian nations, where persons over the age of 65 represent a rapidly growing segment of the population. This study explores the dynamic relationship between participation in social activities and trajectories of depressive symptomatology among older Taiwanese adults surveyed over 18 years.MethodsData are from a nationally representative sample of 1,388 adults aged 60-64 first surveyed in 1989 and followed over an 18-year time period for a total of six waves. Individual involvement in social activities was categorized into continuous participation, ceased participation before age 70, initiating participation in older adulthood, never participated, and dropped out before age 70. Two domains of depressive symptoms--negative affect and lack of positive affect--were measured using a 10-item version of the Center for Epidemiologic Studies-Depression Scale.ResultsAnalyses using growth curve modeling showed that continuously participating or initiating participation in social activities later life is significantly associated with fewer depressive symptoms among older Taiwanese adults, even after controlling for the confounding effects of aging, individual demographic differences, and health status.ConclusionsThese findings suggest that maintaining or initiating social participation in later life benefits the mental health of older adults. Facilitating social activities among older adults is a promising direction for programs intended to promote mental health and successful aging among older adults in Taiwan.

Impact of a Social Influence Intervention on Condom Use and Sexually Transmitted Infections among Establishment-Based Female Sex Workers in the Philippines: A Multilevel Analysis

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.

The Relationship Between HIV/Sexually Transmitted Infection Risk and Alcohol Use During Commercial Sex Episodes: Results From the Study of Female Commercial Sex Workers in the Philippines

The HIV_Sexually Transmitted Infection (STI) risk associated with alcohol use between female commercial sex workers (FCSWs) and their customers has been understudied. We examined this relationship for 1,114 FCSWs aged 15–54 with data collected during the baseline study period (1994 to 1998) in four southern provinces of the Philippines. Two alcohol-related risk situations during commercial sex episodes were examined: prior alcohol use by an FCSW and perceived intoxication in a customer. The influence of sociodemographic variables on sexual risk behaviors was also studied. Multiple sexual risk behaviors were observed with more frequency for FCSWs if alcohol was used before commercial sex or if the episode involved a customer perceived to be intoxicated. Forty-two percent of FCSWs who had sex with an intoxicated customer were STI positive, significantly more than FCSWs who did not have sex with an intoxicated customer (28%, p <. 01). Similar significant differences were found for FCSWs who did not consume alcohol before having sex and were STI positive (29%) versus FCSW who did consume alcohol before sex and were STI positive (33%, p <. 01). Our analyses reinforce accumulating evidence in the field that sexual risk reduction interventions need to go beyond the behaviors of individual FCSWs to meet the layering of risks such as observed in this study. Multilevel strategies targeting customer substance use and other situational and structural factors have proven to be pivotal mediators in our other research with this population. These experiences and the limitations of this study are discussed.

Do older adults become more depressed with age in Taiwan? The role of social position and birth cohort

Background: Depression is one of the most commonly encountered mental health problems during older adulthood. This study examines differences in depressive symptom trajectories among older Taiwanese adults across two birth cohorts (1920–1924 and 1925–1929), and explores the relationships between socioeconomic position (SEP) variables and symptom trajectories. Methods: Data from the Taiwan Longitudinal Study on Aging (TLSA) collected between 1989 and 2003 were analysed. The nationally representative sample is composed of community-living adults (n = 2458) in Taiwan aged 60 years and above. Two distinct domains of depressive symptomatology, negative affect and lack of positive affect, assessed by the short form of the Center of Epidemiological Studies–Depression (CES-D) scale were used for all the analyses. Growth curve models were employed to assess the trajectories of depressive symptoms over time. Results: The relationship between ageing and depressive symptoms appeared linear with a minor curvilinear effect. The depressive symptoms in negative affect increased with age (mean linear growth rate  = 0.26, p<0.001) but levelled off (mean quadric growth rate  = −0.01, p<0.001), while the symptoms in lack of positive affect displayed an opposite trend. The effects of SEP variables also differed by cohort and outcome domain. Conclusions: Remaining active, living with family and having a high level of education are associated with positive affect later in life, while financial strain and poor health are strongly related to negative affect. These results underline the continued role that SEP plays in psychological adjustment over the course of one’s life, independently of ageing.

Reducing alcohol use, sex risk behaviors, and sexually transmitted infections among Filipina female bar workers: effects of an ecological intervention.

This article presents the outcomes of a quasi-experimental community-based research intervention initiative targeting sexually transmitted infections (STIs) testing and condom use among Filipina female bar workers (FBWs). Established at the peer, organizational, and policy levels, bar managers and peer educators from 110 different establishments, in 4 southern Philippines regions, were trained. Only FBWs in the combination peer educator and manager training intervention condition significantly increased STI testing from baseline to follow-up. STI testing was significantly associated with higher HIV/AIDS knowledge, lower probability of contracting HIV, and increased condom use. Based on the findings, future research on the adaptability of this intervention to FBWs residing in HIV epicenters is warranted.

Economic strain and well-being in late life: findings from an 18-year population-based longitudinal study of older Taiwanese adults

BACKGROUND This study estimates the concurrent and longitudinal effects of perceived economic strain and socioeconomic status (SES) on well-being of older adults in Taiwan. METHODS This study uses data from the Taiwan Longitudinal Study on Aging, a nationally representative sample (n= 3602) of older adults aged 60 and above. Participants were interviewed and followed for 18 years. Individual well-being is measured by self-reported life satisfaction, psychological distress and perceived health status. Generalized linear modeling with the generalized estimating equation estimates is used to predict the relationships between perceived economic strain, SES and well-being cross-sectionally and longitudinally, controlling for individual background characteristics, physical health and survival status. RESULTS Older adults who experienced economic strain had significantly poorer well-being in comparison to older adults without strain, both cross-sectionally and longitudinally, controlling for SES and other covariates. In contrast, SES indicators did not consistently predict well-being in the cross-sectional and longitudinal analyses. CONCLUSIONS These findings suggest a strong, cumulative, negative effect of perceived economic strain on well-being among older adults. Health-care initiatives aiming at promoting well-being among older adults should consider the impact of economic strain, which may increase at the end of the life course and threaten health and functioning.

Individual- and community-level determinants of social acceptance of people living with HIV in Kenya: results from a national population-based survey.

Using the 2003 Kenya Demographic and Health Survey, we investigated the influence of individual- and community-level factors on accepting attitudes toward people living with HIV (PLHIV) using three outcomes: (1) willingness to care for an infected household member, (2) willingness to buy vegetables from an infected vendor, and (3) willingness to allow an infected female teacher to continue teaching. In multilevel logistic regression models, we found that individuals who expressed greater acceptance of PLHIV were more likely to be male, older, more educated, high AIDS knowledge, and exposed to mass media. At the community level, differences in accepting attitudes were associated with community AIDS knowledge, community education, and community AIDS experience, but not for region, or place of residence. The findings suggest the important role of community factors in determining social acceptance of PLHIV. Programmatic strategies aimed at increasing these accepting attitudes should consider both individual- and community-level factors.

Exploring the relationship between premarital sex and cigarette/alcohol use among college students in Taiwan: a cohort study.

BackgroundCigarette/alcohol use and premarital sex, and their subsequent consequences on the well-being of college students, are international health promotion issues. However, little is known about the temporal relationship of these risk behaviors among Taiwanese college students.MethodsThis study utilizes data from the Taiwan Youth Project, a cohort sample of 20-year-olds (N = 2,119) with a 2-year follow-up, to explore the relationship between adolescent cigarette/alcohol use, and subsequent premarital sex. To incorporate the Taiwanese context where the normative value of abstinence until marriage remains strong, multivariate logistic regression models included data on premarital sex attitudes, stressful life events, peer influence, as well as family and individual factors which might influence this relationship.ResultsThe sample consists of 49% male and 51% female college students. About 16% of the sample report having had premarital sex by age 20. After excluding sexually active youth, 20% of males and 13% of females report engaging in premarital sex in the 2-year follow-up interview. Multivariate logistic regression analyses reveal adolescent alcohol use is significantly associated with a higher likelihood of engaging in premarital sex for both genders; adolescent smoking is significantly associated with premarital sexual activity among males, but not females. Our results indicate liberal premarital sexual attitudes and stressful personal events are also significantly associated with premarital sexual activity.ConclusionsThese findings suggest health promotion programs for college students need to take developmental and gender perspectives into account. Future research to incorporate a broader, multi-cultural context into risk reduction materials is recommended.

Health status, social support, and quality of life among family carers of adults with profound intellectual and multiple disabilities (PIMD) in Taiwan

Abstract Background Primary family carers of adults with profound intellectual and multiple disabilities (PIMD) experience a range of considerable demands. Method A census survey was conducted in a city of Taiwan; 796 family carers of adults (aged 18 or older) diagnosed with intellectual disability and/or with multiple disabilities living with the family completed interviews. Results Adults with PIMD made up 9.5% of this group (n = 76). Nonparametric analyses showed that health status, formal social support, and quality of life (QoL; physical domain score) of carers of adults with PIMD were significantly lower than their counterparts (i.e., carers of adults with less severe disability), and that these variables were significantly associated with carer educational level, employment status, family income, and social networks. Conclusions Interventions need to include the creation of a supportive environment for adults with PIMD and their lifelong family carers, particularly those who are more socially disadvantaged.

Trends in Primary and Secondary Abstinence among Kenyan Youth

Abstract We used data from Kenya Demographic and Health Surveys in 1993, 1998, and 2003 to examine 10-year trends in primary and secondary abstinence among never-married youth aged 15–24 and to explore the role of HIV prevention knowledge, schooling, and contextual factors in affecting their abstinence behaviors. Our analysis shows that both primary and secondary abstinence levels have risen in the past 10 years, with the abstinence levels higher among females than among males. Logistic regression models indicate that knowledge that abstinence can prevent HIV infection was positively associated with the likelihood of practicing abstinence. However, knowledge that condom use can prevent HIV infection was associated with lower abstinence practice. In-school youth were more likely to abstain from sex than those working. Effects of the contextual variables were only significant on the likelihood of primary abstinence among female youth. These findings suggest abstinence programs needed to be gender sensitive and culturally appropriate.