Esme Fuller-Thomson

The health of grandparents raising grandchildren: results of a national study.

OBJECTIVES This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed.

Depression and inflammatory bowel disease: Findings from two nationally representative Canadian surveys

&NA; Most studies of depression and inflammatory bowel disease (IBD) have been drawn from clinical populations or from samples selected from the membership of Crohns and ulcerative colitis community organizations. This study determined the prevalence and correlates of depression in people with IBD or a similar bowel disorder from 2 nationally representative Canadian surveys. In the Canadian Community Health Survey, conducted in 2000 through 2001, there were 3076 respondents who reported that they had “a bowel disorder such as Crohns disease or colitis” that had lasted ≥6 months and had been diagnosed by a health professional. The National Population Health Survey, conducted from 1996 through 1997, had 1438 respondents who reported that they had such a condition. Within each subsample, bivariate analyses were conducted to compare the depressed and nondepressed individuals. Logistic regression analyses also were conducted using the Canadian Community Health Survey 1.1 data set. The 12‐month period prevalence of depression among individuals with IBD and similar bowel disorders was comparable in the 2 data sets (16.3% and 14.7%). Depression rates were higher among female respondents, those without partners, younger respondents, those who reported greater pain, and those who had functional limitations. Seventeen percent of depressed respondents had considered suicide in the past 12 months; an additional 30% had considered suicide at an earlier time. Only 40% of depressed individuals were using antidepressants. Individuals with IBD and similar bowel disorders experience rates of depression that are triple those of the general population. It is important for clinicians to assess depression and suicidal ideation among their patients with active IBD symptoms, particularly among those reporting moderate to severe pain.

Basic ADL Disability and Functional Limitation Rates Among Older Americans From 2000–2005: The End of the Decline?

BACKGROUND This study sought to determine whether the rates of basic activities of daily living (ADL) disabilities and functional limitations declined, remained the same, or increased between 2000 and 2005 when (a) only community-dwelling Americans aged 65 and older were examined and (b) when institutionalized older adults were included. METHOD Using data from the American Community Survey and the National Nursing Home Survey, we calculated annual prevalence rates of basic ADL disabilities and functional limitations and fitted regression lines to examine trends over time. RESULTS The rates of basic ADL disabilities among community-dwelling adults aged 65 and older increased 9% between 2000 and 2005. When institutionalized elders were included, basic ADL disability rates were stable among men but increased among women. Functional limitation rates did not significantly change between 2000 and 2005. CONCLUSION These findings suggest an end of the decline in disability rates among older Americans, which, if confirmed, could have important implications for health care.

Making a link between childhood physical abuse and cancer: results from a regional representative survey.

Abuse in childhood is associated with many negative adult health outcomes. Only 1 study to date has found an association between childhood abuse and cancer. By using a regionally representative community sample, this preliminary study sought to investigate the association between childhood physical abuse and cancer while controlling for 3 clusters of risk factors: childhood stressors, adult health behaviors, and adult socioeconomic status.

The housing/health relationship: what do we know?

Research into the relationship between housing and health has frequently been narrowly focused, fragmented, and of marginal practical relevance to either housing or health policy. From an extensive review of the literature, this paper reports on the current state of knowledge about the relationship between housing and health. The research falls into four distinct categories: (1) specific physical or chemical exposures; (2) specific biological exposures; (3) physical characteristics of the house; and (4) social, economic, and cultural characteristics of housing. Much of the general literature on the effects of housing on health cites previous studies and then proceeds to advocate housing policies and strategies that are aimed at improving population health. Studies providing original data on the relationship, which is the vast majority of the literature, focus on very specific physical, chemical, and biological exposures with a known or suspected effect on health within the house, or they focus on the social, economic, and cultural characteristics of the house. The mechanisms through which specific aspects of housing affect health are extremely complicated, but they do exist. Researchers have made a great deal of progress in clarifying some of these mechanisms. A large gap still exists in our knowledge about the links and pathways between housing, socio-economic status and health status.

The association between childhood physical abuse and heart disease in adulthood: findings from a representative community sample.

OBJECTIVES Although, the relationship between childhood physical abuse and adult heart disease has been documented, very few studies have controlled for many of the known risk factors for heart disease. The objective of the current study, therefore, was to investigate the association between childhood physical abuse and adult heart disease while controlling for the following established risk factors: (1) childhood stressors; (2) adult health behaviors; (3) adult stressors; (4) depression; and, (5) high pressure. METHODS Data was obtained from the 2005 Canadian Community Health Survey. The sample included 13,093 respondents from the Canadian provinces of Manitoba and Saskatchewan, of whom 7.4% (n=1025) reported that they had been physically abused as a child by someone close to them and 4.4% (n=850) reported that they had been diagnosed with heart disease by a health professional. The regional level response rate was 84%. RESULTS The age-gender-race adjusted odds ratio of heart disease among those who had reported childhood physical abuse was 1.57 (95% CI=1.12, 2.20). When adjustments were made for all of the established risk factors the odds ratio declined to 1.45 (95% CI=1.01, 2.08). CONCLUSIONS The relationship between childhood physical abuse and heart disease persists even when controlling for five types of factors previously thought to mediate the relationship. PRACTICE IMPLICATIONS Further research would benefit from a closer analysis of the potential mechanisms linking childhood physical abuse and heart disease.

Black—White Disparities in Disability Among Older Americans: Further Untangling the Role of Race and Socioeconomic Status

Objectives: To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans. Method: Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities. Results: Ninety percent of the Black—White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education. Discussion: The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black—White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.

The association between depression and epilepsy in a nationally representative sample

Purpose:  To determine the: (1) national prevalence of epilepsy and depression; (2) prevalence of depression among those with epilepsy; (3) odds ratio of depression among those with epilepsy compared to those without, controlling for demographic characteristics; (4) demographic correlates of depression among those with epilepsy and those without; and, (5) health services utilization of those with epilepsy and depression.

Canadian First Nations Grandparents Raising Grandchildren: A Portrait in Resilience

Between 1991 and 2001, there was a 20% increase in the number of Canadian children under 18 years old who were living with their grandparents without a parent present in the home. Recent research revealed that Canadians of First Nations origin, including North American Indians, Metis, and Inuit, were vastly over-represented among grandparents raising grandchildren in skipped generation households (households which include only grandparents and grandchildren). Using custom tabulation data from the 1996 Canadian Census, this article presents a profile of First Nations Canadian grandparents raising grandchildren in skipped generation households. Despite extremely high rates of poverty and disability, one-third of First Nations Canadian skipped generation families were raising two or more grandchildren. In comparison to other grandparent caregivers, First Nations custodial caregivers were more likely to also be caring for a senior (23%) and to spend more than 30 hours a week on childcare duties (46%) and on housework (41%). Implications for policy, practice, and research are discussed.

Making health data maps: a case study of a community/university research collaboration.

This paper presents the main findings from a collaborative community/university research project in Canada. The goal of the project was to improve access to community health information, and in so doing, enhance our knowledge of the development of community health information resources and community/university collaboration. The project built on a rich history of community/university collaboration in Southeast Toronto (SETO), and employed an interdisciplinary applied research and action design. Specific project objectives were to: (1) develop via active community/university collaboration a geographic information system (GIS) for ready access to routinely collected health data, and to study logistical, conceptual and technical problems encountered during system development; and (2) to document and analyze issues that can emerge in the process of community/university research collaboration. System development involved iteration through community user assessment of need, development or refinement of the GIS, and assessment of the GIS by community users. Collaborative process assessment entailed analysis of archival material, interviews with investigators and participant observation. Over the course of the project, a system was successfully developed, and favorably assessed by users. System development problems fell into four main areas: maintaining user involvement in system development, understanding and integrating data, bringing disparate data sources together, and making use of assembled data. Major themes emerging from the community/university collaborative research process included separate community and university cultures, time as an important issue for all involved, and the impact of uncertainty and ambiguity on the collaborative process.