Denise Burnette

Grandparents Raising Grandchildren in the Inner City

Increasingly, middle-aged and older adults are parenting grandchildren and other young kin in ‘skipped generation’ families. Changes in the multigenerational family structure, devastating social problems in our inner cities, notably the substance-abuse and HIV/AIDS epidemics of the 1980s, and public policy and ethnocultural norms that govern kin care are discussed as contributing factors to this phenomenon. Recent studies focusing on grandparent caregivers of color, as well as policy and programmatic responses to the rapid growth of this family configuration, are discussed. The author offers recommendations for assessing and building on existing strengths and addressing the service needs of grandparent caregivers and their families through direct practice and public policy.

Physician utilization by Hispanic elderly persons: national perspective.

BACKGROUND The number of elderly Hispanic Americans is projected to more than double by 2010 and account for 16% of all elders by 2050. The complex health needs and diversity of that growing population poses challenges for planning and delivery of health services. OBJECTIVES The behavioral model of health services utilization was used to examine predisposing, enabling, and need factors associated with physician use by Hispanic elders and to assess whether Mexican American, Cuban American, and Puerto Rican elders differ in their likelihood of use. RESEARCH DESIGN Data are from the 1988 National Survey of Hispanic Elderly People, which is a nationally representative sample of Hispanic elders living within telephone exchanges with at least 30% concentration of Hispanics. SUBJECTS There were 2,299 completed interviews. Analyses are based on a subsample of 773 Mexican Americans, 714 Cuban Americans, and 368 Puerto Ricans. MEASURES The dependent variable, physician utilization, was self-reported number of visits in the previous year. It was dichotomized because of skewness. Independent variables include predisposing, enabling, and need factors. RESULTS Using hierarchical logistic regression, all three sets of factors contributed to the likelihood of a visit. Enabling factors, especially insurance coverage and adult children, had the greatest impact. Cuban Americans and Puerto Ricans were 2.3 and 2.6 times more likely, respectively, to have seen a physician than were Mexican Americans. CONCLUSIONS In seeking to improve access and use of physician services, health care providers and policy makers should consider the role of social and economic factors and national origin group.

Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples

BACKGROUND Prior research with racially/ethnically homogeneous samples has demonstrated widespread co-occurrence of psychotic experiences (PEs) and common mental health conditions, particularly multi-morbidity, suggesting that psychosis may be related to the overall severity of psychiatric disorder rather than any specific subtype. In this study we aimed to examine whether PEs are associated with the presence of specific disorders or multi-morbidity of co-occurring disorders across four large racially/ethnically diverse samples of adults in the USA. METHOD Data were drawn from the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and separately from the Asian and Latino subsamples of the National Latino and Asian American Study (NLAAS). Logistic regression models were used to examine the relationship between PEs and individual subtypes of DSM-IV disorder, and to test for a linear dose-response relationship between the number of subtypes and PEs. RESULTS Prevalence of PEs was moderately greater among individuals with each subtype of disorder in each data set [odds ratios (ORs) 1.8-3.8], although associations were only variably significant when controlling for clinical and demographic variables. However, the sum of disorder subtypes was related to odds for PEs in a linear dose-response fashion across all four samples. CONCLUSIONS PEs are related primarily to the extent or severity of psychiatric illness, as indicated by the presence of multiple psychiatric disorders, rather than to any particular subtype of disorder in these data. This relationship applies to the general population and across diverse racial/ethnic groups.

The influence of ethnicity and culture on dementia caregiving: A review of empirical studies on Chinese Americans

The purpose of this article is to pinpoint the cultural and ethnic influences on dementia caregiving in Chinese American families through a systemic review and analysis of published research findings. Eighteen publications on Chinese American dementia family caregivers published in peer-reviewed journals between 1990 and early 2011 were identified. Based on a systematic database search and review process, we found that caregivers’ beliefs concerning dementia and the concept of family harmony as evidenced through the practice of filial piety are permeating cultural values, which together affect attitudes toward research and help-seeking behaviors (ie, seeking information on diagnosis and using formal services). There is also evidence to suggest that these cultural beliefs impinge on key elements of the caregiving process, including caregivers’ appraisal of stress, coping strategies, and informal and formal support. The study concludes with recommendations for future research and practice with the Chinese American population.

Determinants of Self-Reported Depressive Symptoms by Frail Elderly Persons Living Alone

This study examined the effeci of life sbessors and psychosocial resources on self-reported depressive symptoms for frail elderly living alone in the 1982-84 National Long-Term Care Channeling Demonstration (N = 2,081). Significant predictors of depressive symptoms were being white, less education, more ADL impairment, more physical illness and poorer perceived health, more perceived unmet needs, less sense of control, and more informal helpers and the interaction of social participation and loss of a signif- icant other. Implications for research on the relation of these factors among the frail elderly are addressed.

Grandparents Rearing Grandchildren: A School-Based Small Group Intervention

Although support groups are the most popular source of education and support for the growing number of grandparents who are rearing their grandchildren, the nature and efficacy of these groups have not been documented. This article presents data from an exploratory study of an 8-week school-based small group intervention. Comparison of pre- and posttest measures showed a reduction in depressive symptoms and in use of distancing as a coping strategy. Seeking social support and planful problem solving increased, as did knowledge about grandparent- related social services. Implications for social work practice and future research are discussed.

Grandparents as Family Caregivers: Lessons for Intergenerational Education

The number of grandparents who have responsibility for raising grandchildren has increased dramatically over the past several decades. From an educational perspective, content on custodial grandparents can promote an increased interest in, and understanding of the complexities of aging, by stressing the intergenerational aspects of this family form. This paper describes the growing population of custodial grandparents, and the larger socio-environmental contexts of these families. In addition, it highlights instructional approaches for including content on grandparent-headed families within didactic and experimental courses.

Gender, Self-Care and Functional Status Among Older Persons with Coronary Heart Disease: A National Perspective

ABSTRACT The risk and burdens of cardiovascular diseases rise in late life and shift from men to women at age 65. This study uses baseline data from the National Survey of Self-Care and Aging to assess the association of self-care and functional status of older men and women with coronary heart disease (CHD). We first compare men and women with and without CHD, then base subsequent analyses on 597 persons with CHD. Three types of self-care (behavior changes, environmental adaptations, medical equipment use) were examined, and functional status was measured as difficulty with basic, mobility, and instrumental ADLs. Regardless of gender, persons with CHD had more functional impairment and used more self-care than those without the disease. Women were more impaired and engaged in more self-care than men. Equipment use was associated with higher functioning for men and women. Behavioral changes were significant only for men, as were advanced age, non-white ethnicity, more depressive symptoms, and low physical activity for women. Education, intervention, and supportive care for older adults with CHD should consider the role of specific types of self-care in disease management and prevention of decline as well as gender differences in use of various self-care strategies.

Parent–Adolescent Communication About Sex in Rural India: U.S.–India Collaboration to Prevent Adolescent HIV

In this article, we examine parent–adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.

India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth

BackgroundDespite the centrality of family in Indian society, relatively little is known about family-based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family-based adolescent HIV-prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family-based HIV-prevention intervention for rural Indian adolescents.MethodsEight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same-gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family-based intervention to reduce adolescent vulnerability to HIV infection.ResultsSix primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family-based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention.ConclusionDespite suggestions that family-based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family-based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families.