Diana M. DiNitto

The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use.

Background Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts—homebound adults under age 60. Methods Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78% were age 60 years and older and 22% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models. Results Only 34% of the under-60 group and 17% of the 60 years and older group currently used the Internet, and 35% and 16% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language. Conclusions This study is the first to describe in detail low-income disabled and homebound adults’ and older adults’ Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided.

Advancement for Women in Hierarchical Organizations: A Multilevel Analysis of Problems and Prospects

Womens problems and prospects for advancement to upper level positions in hierarchical organizations are analyzed within a five-level framework of social organization. The five levels are (1) societal; (2) institutional; (3) organizational; (4) role; and (5) individual. Corresponding units of analysisfor each level are identified and discussed. To illustrate the framework, two problems confronting women are identified for each level, along with possible corrective actions. Conclusions are that (1) fundamental change in womens status in hierarchical work organizations will require simultaneous efforts on all five levels of social organization; (2) change in any realm requires political action against ideological justifications and claims for womens exclusion; and (3) the division of labor between the sexes in relation to work and child/family/home responsibilities must change before women can receive equitable treatment in the workplace. The authors call for more research on the interrelations between influences and factors across levels of social organization.

Internet Use Among Older Adults: Association With Health Needs, Psychological Capital, and Social Capital

Background Previous studies have identified socioeconomic status and health status as predictors of older adults’ computer and Internet use, but researchers have not examined the relationships between older adults’ health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use. Objective This study examined (1) whether older adults’ health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital. Methods Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others’ homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users. Results Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95% CI 0.70-0.98, P=.03 and OR 0.79, 95% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95% CI 1.08-1.23, P<.001) and 1.28 (95% CI 1.05-1.57, P=.02), respectively, but anxiety symptoms decreased the odds (OR 0.74, 95% CI 0.55-0.99, P=.05). Religious service attendance was negatively associated with Internet use for shopping/banking activities (OR 0.75, 95% CI 0.62-0.91, P=.01). Anxiety symptoms increased the odds of using the Internet only for emails/texting (OR 1.75, 95% CI 1.12-2.75, P=.02), but formal volunteering decreased the odds (OR 0.63, 95% CI 0.43-0.92, P=.02). Other correlates of Internet use solely for emails/texting were older age (80-84 years and ≥85 years), a black or “other” racial/ethnic background, a high school education or less than high school, and lower income. Conclusions The findings point to the importance of social capital in facilitating older adults’ learning and adoption of Internet technology. Older adults who used the Internet for email/texting purposes only were the most socially and economically disadvantaged group of Internet users. Computer/Internet training for older adults and computer/Internet use for various purposes need to consider the significant role their social capital can play.

Heavy/binge drinking and depressive symptoms in older adults: gender differences

The purpose of this study was to examine gender similarity/difference in the association between depressive symptoms (11‐item Center for Epidemiologic Scale for Depression (CES‐D) scores), on the one hand, and frequency and amount of alcohol use, on the other, among older adults.

Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults

BACKGROUND This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26-34, 35-49, and 50-64 years old. METHODS Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses. RESULTS The 65+ age group was least likely to use treatment and perceive treatment need, but the 50-64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment. CONCLUSIONS Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment.

The Effectiveness of an Integrated Treatment Approach for Clients With Dual Diagnoses

Objective: A randomized experiment tested the effectiveness of adding a psychoeducationally oriented group therapy intervention, Good Chemistry Groups, to standard inpatient chemical dependency services for clients dually diagnosed with mental and substance dependence disorders. Method: Ninety-seven clients were randomly assigned to an experimental group (n = 48) and a control group (n = 49). Outcome variables included drug and alcohol use, participation in self-help support group meetings, incarceration days, psychiatric symptoms, psychiatric inpatient admissions, compliance with prescribed psychotropic medication plans, and composite scores on the Addiction Severity Index. Results: No significant treatment effects were found on any of the outcome variables. The findings were generally consistent with those of prior controlled studies. Conclusion: Good Chemistry Groups did not add to the effects of standard treatments for dually diagnosed clients. Practitioners should continue to develop and evaluate alternative integrated treatment approaches that might prove to be more effective than this one.

Marijuana use among older adults in the U.S.A.: user characteristics, patterns of use, and implications for intervention

BACKGROUND Epidemiological studies show that the number of older adults using marijuana is increasing. This study aimed to determine the correlates and patterns of marijuana use among older adults that might help health and social service providers better assist this group. METHODS Data are from the 2008 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration in the U.S.A. The sample consisted of 5,325 adults aged 50 years and older. RESULTS Of the sample, 2.8% were past-year marijuana users. Of them, 23% had used marijuana on at least half the days of the year. Past-year users were more likely to be younger (50-64 years old), black, and not married, and they had significantly higher psychological distress scores, but they did not rate their health as poorer than others in the sample, nor did they attribute many problems, including psychological problems, as being related to their marijuana use. Nevertheless, past-year users present a high-risk profile because, in addition to frequent marijuana use, they also are more likely to smoke cigarettes, engage in binge drinking, and use other illicit drugs. CONCLUSIONS Health and social service providers should be alert to the small number of routine marijuana users among the younger members of the older adult population, especially those suffering significant psychological distress, so that these individuals can be encouraged to utilize services that will help alleviate this distress and promote a healthier lifestyle and increase general well being.

Grand Challenges for Social Work

This invited article introduces the concept of grand challenges—ambitious yet achievable goals for society that mobilize the profession, capture the public’s imagination, and require innovation and breakthroughs in science and practice to achieve (Kalil, 2012). We call for broad and deep participation of social work scientists and practitioners in the Grand Challenges for Social Work initiative, which will be coordinated by the American Academy of Social Work and Social Welfare.

Gender Differences in Dually-Diagnosed Clients Receiving Chemical Dependency Treatment

Abstract This article considers gender differences among 97 clients with dual diagnoses of severe mental illness and chemical dependency (46 male and 51 female). Comparisons are made at the time of their admission to an inpatient chemical dependency treatment program and at follow-up in cases where data are available. Many of the findings at time of admission are consistent with the few studies that have compared men and women with co-occurring mental and substance use disorders. For example, the women were more likely to have experienced emotional, physical, or sexual abuse, and they reported being charged with fewer types of crimes. Most differences at admission concerned psychiatric problems and family/social relations. Women reported that they were more bothered by their psychiatric symptoms and their family/social relations, but they also reported more happiness and closeness in some relationships. The women also said they had more relatives with alcohol, drug, and especially psychiatric, problems. At follow-up, gender differences in the family/social and psychiatric domains persisted. Findings suggest that men and women with dual diagnoses might benefit from different emphases in treatment programs.

Discrepancy between chronological age and felt age: age group difference in objective and subjective health as correlates.

Objective: Guided by the social comparison theory, we examined correlates of the discrepancy between chronological and felt ages in three age groups of community-dwelling older adults: 65 to 69, 70 to 79, and 80 and older. Method: Data from the National Health and Aging Trends Study and linear regression models were used to test the hypothesis that age discrepancy would be significantly associated with objective health indicators among those in the 65 to 69 and 70 to 79 age groups but not among the 80+ group. Results: Objective health indicators were significantly associated with age discrepancy only in the 70 to 79 age group, while subjective health perceptions and psychological well-being were significantly associated with age discrepancy in all age groups. Discussion: The correlates of the discrepancy in the 65 to 69 age group appear to resemble those in the 80+ group more than those in the 70 to 79 age group. Further research is needed to identify the determinants of age group differences.