Chivon A. Mingo

Reconceptualizing Successful Aging Among Black Women and the Relevance of the Strong Black Woman Archetype

Although there are multiple pathways to successful aging, little is known of what it means to age successfully among black women. There is a growing body of literature suggesting that black women experience a number of social challenges (sexism and racism) that may present as barriers to aging successfully. Applying aspects of the Strong Black Women ideal, into theoretical concepts of successful aging, may be particularly relevant in understanding which factors impair or promote the ability of black women to age successfully. The Strong Black Women archetype is a culturally salient ideal prescribing that black women render a guise of self-reliance, selflessness, and psychological, emotional, and physical strength. Although this ideal has received considerable attention in the behavioral sciences, it has been largely absent within the gerontology field. Nevertheless, understanding the dynamics of this cultural ideal may enhance our knowledge while developing an appreciation of the black womans ability to age successfully. Rather than summarize the social, physical, and mental health literature focusing on health outcomes of black women, this conceptual review examines the Strong Black Women archetype and its application to the lived experiences of black women and contributions to current theories of successful aging. Focusing on successful aging exclusively among black women enhances our understanding of this group by considering their identity as women of color while recognizing factors that dictate their ability to age successfully.

Reaching Diverse Participants Utilizing a Diverse Delivery Infrastructure: A Replication Study

This replication study examines participant recruitment and program adoption aspects of disease self-management programs by delivery site types. Data were analyzed from 58,526 adults collected during a national dissemination of the Stanford suite of chronic disease self-management education programs spanning 45 states, the District of Columbia, and Puerto Rico. Participant data were analyzed using multinomial logistic regression to generate profiles by delivery site type. Profiles were created for the five leading delivery site types, which included senior centers or area agencies on aging, residential facilities, healthcare organizations, community or multi-purpose centers, and faith-based organizations. Significant variation in neighborhood characteristics (e.g., rurality, median household income, percent of the population age 65 years and older, percent of the population i.e., non-Hispanic white) and participant characteristics (e.g., age, sex, ethnicity, race, rurality) were observed by delivery site type. Study findings confirm that these evidence-based programs are capable of reaching large numbers of diverse participants through the aging services network. Given the importance of participant reach and program adoption to the success of translational research dissemination initiatives, these findings can assist program deliverers to create strategic plans to engage community partners to diversify their participant base.

Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model

Purpose of the Study Despite the growing prevalence of multiple chronic conditions (MCC), a problem that disproportionally affects older adults, few studies have examined the impact of MCC status on changes in workforce participation in later life. Recent research suggests that resilience, the ability to recover from adversity, may buffer the negative impact of chronic disease. Guided by an adapted socio-ecological risk and resilience conceptual model, this study examined the buffering effect of resilience on the relationship between individual and contextual risks, including MCC, and workforce transitions (i.e., leaving the workforce, working fewer hours, working the same hours, or working more hours). Design and Methods Using the Health and Retirement Study, this study pooled a sample of 4,861 older workers aged 51 and older with 2 consecutive biannual waves of data. Nonnested multinomial logistic regression analysis was applied. Results MCC are related to higher risk of transitioning out of the workforce. Resilience buffered the negative effects of MCC on workforce engagement and remained independently associated with increased probability of working the same or more hours compared with leaving work. Implications MCC are associated with movement out of the paid workforce in later life. Despite the challenges MCC impose on older workers, having higher levels of resilience may provide the psychological resources needed to sustain work engagement in the face of new deficits. These findings suggest that identifying ways to bolster resilience may enhance the longevity of productive workforce engagement.

Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults.

Explaining the Relationship between Pain and Depressive Symptoms in African-American and White Women with Arthritis

Arthritis is a common chronic illness that disproportionately affects women and African Americans and is often associated with depression. The mechanisms through which arthritis-related pain are associated with depression remain unclear. This study examined the relationship between arthritis-related pain and depressive symptoms to determine if functional impairment and sense of mastery mediated this relationship. Participants included 77 African-American and 98 white women with arthritis (aged 45-90) who completed structured questionnaires assessing pain, functional impairment, sense of mastery and depressive symptoms. Regression analyses showed that sense of mastery and functional impairment partially mediated the relationship between pain and depressive symptoms for whites such that the previously significant pain-depression relationship (beta = 0.40, p < 0.001) was no longer significant (beta = 0.05, p = 0.62). Only sense of mastery partially mediated between pain and depressive symptoms for African Americans. Again, the previously significant pain-depression relationship (beta = 0.32, p < 0.01) was reduced (beta = 0.16, p = 0.19). Implications of the study suggest that it is important for service providers and healthcare professionals to be aware of different lifetime experiences and perceptions of illness in order to better serve the needs of women from different race groups.

Impact of race and diagnostic label on older adults' emotions, illness beliefs, and willingness to help a family member with osteoarthritis.

Objective: To examine how race and the diagnostic label of Osteoarthritis (OA) affects older adults’ emotions, illness beliefs, and willingness to help a family member. Methods: African American and White older adults were randomly assigned to read vignettes describing a sister suffering from chronic pain and disability, either with or without the OA label. Race × diagnostic label ANOVAs were conducted. Results: Compared to Whites, African Americans were more optimistic that OA could improve with health care, and showed greater willingness to help their sister. The OA label had little impact on emotions, beliefs, or willingness to help. African Americans rated the sister as having more control of their problem than Whites without the OA label, but providing the diagnosis eliminated this difference. Discussion: The diagnostic label of OA had little effect on these older adults, but racial differences indicate that cultural values regarding family caregiving are important in arthritis care.

Chronic Disease Self-Management Education (CDSME) program delivery and attendance among urban-dwelling African Americans

Background Older African Americans carry a disproportionate share of chronic diseases. The purpose of this study was to identify the characteristics of urban-dwelling African Americans with chronic disease participating in Chronic Disease Self-Management Education (CDSME) programs and to examine factors related to successful program completion (i.e., attending at least four of the six sessions). Methods Data were analyzed from 11,895 African Americans who attended a CDSME program at one of the five leading delivery sites (i.e., senior center, health care organization, residential facility, community location, faith-based organization). Logistic regression analyses were used to assess the associations of demographic, delivery site, and neighborhood characteristics with CDSME program successful completion. Results Approximately, half of the African American participants were aged 65–79 years, 83% were female, and 92% lived alone. Approximately, 44% of participants had three or more chronic conditions and 35% resided in an impoverished area (i.e., 200% below federal poverty level). Successful completion of the CDSME program was associated with being between the ages of 50–64 and 65–79 years, being female, living alone, living in an impoverished community, and attending a CDSME program at a residential facility or community center. Conclusion Findings highlight the unique patterns of attendance and delivery within the context of self-management interventions among this unique and traditionally underserved target population. Understanding such patterns can inform policy and practice efforts to engage more organizations in urban areas to increase CDSME program adoption. Particularly, employing strategies to implement CDSME programs across all delivery site types may increase reach to African American participants.

Impact of the Arthritis Foundation's Walk With Ease program on arthritis symptoms in African Americans

Introduction Inadequate program design and lack of access to evidence-based programs are major barriers to the management of chronic diseases such as arthritis, particularly for African Americans. This study evaluates the effectiveness of the Arthritis Foundation’s Walk With Ease Program (WWE) in a subsample of African Americans who were part of a larger study that established evidence of the program’s efficacy. Methods Participants were African Americans (N = 117) with self-reported arthritis who chose to participate in either a self-directed (n = 68) or group (n = 49) 6-week WWE program. Arthritis-related symptoms (ie, pain, fatigue, stiffness; measured using visual analog scales) were assessed at baseline, 6 weeks, and 1 year. Independent samples t tests were conducted to examine group differences (ie, self-directed vs group) in arthritis-related symptoms at baseline, and paired sample t tests were conducted to examine differences over time (ie, baseline to 6 weeks and baseline to 1 year) in symptoms. Satisfaction was examined by descriptive statistics. Results Younger, more educated individuals chose the self-directed format (P < .001, P = .008; respectively). After the 6-week intervention, participants reported a decrease in pain (P < .001), fatigue (P = .002), and stiffness (P < .001). At 1 year, the decrease in pain (P = .04) and stiffness (P = .002) remained constant. Overall, participants were satisfied with both program formats. Conclusion The individualized and group formats of the WWE program improved arthritis-related pain, fatigue, and stiffness in African Americans. Culturally appealing arthritis interventions ultimately may increase the use of existing arthritis interventions.

Evaluation of a Laughter-based Exercise Program on Health and Self-efficacy for Exercise.

Background Despite health benefits of physical activity (PA) and risks of physical inactivity, many older adults do not accumulate sufficient levels of PA to achieve associated health benefits. Lack of PA enjoyment may be a barrier to PA participation. Combining simulated laughter and PA for strength, balance, and flexibility is a potential solution for helping older adults maintain independence in activities of daily living through enjoyable participation in PA. Purpose of the study The purpose of this study is to assess whether combining simulated laughter exercises with a moderate-intensity strength, balance, and flexibility PA program (i.e., LaughActive) increases participation in PA, health, and self-efficacy for PA among older adults residing in 4 assisted living facilities (ALFs). Design and methods The 12-week wait list control pilot study used pre- and 6-week post-intervention comparisons within and between groups identified by paired sample t-test results among those who participated in twice-weekly LaughActive classes (n = 27). Results Significant improvements (p < .05-.10) were observed in mental health (SF-36v2), aerobic endurance (2-minute step test), and self-efficacy for exercise (OEE). Implications PA programs that elicit positive emotions through simulated laughter have the potential to improve health, physical performance, and self-efficacy for PA among older adults and may positively influence participant adherence.

Individual and Community Socioeconomic Status: Impact on Mental Health in Individuals with Arthritis

To examine the impact of individual and community socioeconomic status (SES) measures on mental health outcomes in individuals with arthritis, participants with self-reported arthritis completed a telephone survey assessing health status, health attitudes and beliefs, and sociodemographic variables. Regression analyses adjusting for race, gender, BMI, comorbidities, and age were performed to determine the impact of individual and community level SES on mental health outcomes (i.e., Medical Outcomes Study SF-12v2 mental health component, the Centers for Disease Control and Prevention Health-Related Quality of Life Healthy Days Measure, Center for Epidemiological Studies Depression [CES-D] scale). When entered singly, lower education and income, nonmanagerial occupation, non-homeownership, and medium and high community poverty were all significantly associated with poorer mental health outcomes. Income, however, was more strongly associated with the outcomes in comparison to the other SES variables. In a model including all SES measures simultaneously, income was significantly associated with each outcome variable. Lower levels of individual and community SES showed most consistent statistical significance in association with CES-D scores. Results suggest that both individual and community level SES are associated with mental health status in people with arthritis. It is imperative to consider how interventions focused on multilevel SES factors may influence existing disparities.