Jeffrey A. Burr

Racial differences in health and health care service utilization in later life : the effect of socioeconomic status

In this paper we examine the hypothesis that health differences between Blacks and Whites in later life are related to socioeconomic status. Using the 1984 panel of the Survey of Income and Program Participation, we construct four measures of health and two measures of health care service utilization. Multivariate analyses show that the racial differences are eliminated in some measures of health and health care service utilization after holding constant individual-level socioeconomic characteristics and resources. However, even after accounting for differences in socioeconomic status, Black self-rated health is poorer than that of Whites. Further, Blacks report more visits to medical personnel but do not report higher rates of hospitalization when levels of health and economic resources are controlled. Additional analyses suggest that the impact of socioeconomic status on health is different for Blacks than for Whites.

Race and Ethnic Variation in Norms of Filial Responsibility among Older Persons

Race and ethnic diversity in attachment to the norms of intergenerational filial responsibility is examined in a sample of older persons drawn from the National Survey of Families and Households (NSFH). The findings show that older Blacks and Hispanics are more likely than older non-Hispanic Whites to agree that each generation should provide coresidence assistance when needed. In terms of attitudes about exchanging financial aid, there tend to be fewer differences between each group. Moreover, in a longitudinal analysis of living arrangements, the impact of race on the likelihood of living with an adult child is reduced to statistical insignificance when variation in commitment to norms governing coresidence is controlled. Key Words: financial assistance, intergenerational relations, living arrangements, minority status, social support. Interest in the family relationships of older minority persons is driven, in part, by the remarkable growth of these populations in American society (e.g., Angel & Hogan, 1992). The non-Hispanic White majority represented nearly 88% of all persons aged 65 years and older in 1990. About 8% of the older population was composed of Blacks, and about 4%, of Hispanics. Yet, by the year 2050, the United States Census Bureau projects that older Blacks and Hispanics combined may account for as much as 26% of all persons over the age of 65 (Treas & Torrecilha, 1995). Improving mortality risk at younger and older ages, younger age distributions, differential fertility, and recent immigration patterns account for much of this relatively rapid increase of minority groups. One reason this growth is important is that some segments of the population of the minority aged appear to experience increased vulnerability with age, compared with their non-Hispanic White counterparts. For instance, older Blacks and Hispanics are disproportionately more likely than older White persons to be poor, to have poorer health, and to experience more functional limitation. Recent evidence shows that older members of minorities are more likely than their majority counterparts to use certain types of formal services (e.g., Mui, Choi, & Monk, 1998), yet Black and Hispanic elders are less likely to rely on institutions for long-term care. Research published in the 1960s and 1970s suggests that minority elders were at least partially sheltered from the worst outcomes of these risks because they were immersed in strong kin support systems-moreso than Whites. In essence, the research tended to suggest that when it came to the family ties of the older minority person, the norms of filial responsibility were stronger for minorities than for Whites. Recent research, however, shows that differences between Blacks and Whites with respect to the actual exchanges of aid and services between family members may not be as significant as once thought (e.g., Silverstein & Waite, 1993). To understand the association between norms of filial responsibility and actual behavior, research is needed that compares attitudes about intergenerational support across racial and ethnic groups, combined with analyses of the impact of these attitudes on behavior. This article addresses the issue by evaluating two specific features of intergenerational filial responsibility: attitudes about coresidence and providing financial assistance in times of need. We also evaluate whether attitudes about intergenerational coresidence are related to actual living arrangements. We explore differences in attitudes about filial responsibility among Whites, Blacks, and Hispanics using the NSFH. THEORY AND LITERATURE REVIEW Given that family members are the preferred first line of defense for older persons who need assistance, it is helpful to know what motivates family members to assist other family members. One motivation is assumed to be related to normatively based attitudes about responsibility, duty, and obligation toward others in the family unit. …

A Longitudinal Analysis of Household and Nonhousehold Living Arrangements in Later Life

Most explanatory models of living arrangements in later life link the decision process surrounding choice of living arrangement to personal resources such as income and health. Applications of these models, however, are based for the most part on crosssectional rather than longitudinal data. In this paper we examine living arrangements in later life among the nonmarried population aged 55 and over, using data from the Survey of Income and Program Participation. We observe individuals as they change living arrangements, die, or become institutionalized. Our results suggest that economic resources dominate the decision-making process in transitions across different household arrangements, whereas health is most important in explaining institutionalization.

The Living Arrangements of Unmarried Elderly Hispanic Females

In this paper we examine the influence of cultural preferences on living arrangements for a sample of older unmarried Hispanic and non-Hispanic white females. We develop a conceptual framework composed of three sets of factors: availability of kin, economic and health feasibility, and cultural desirability. Our analyses show that household living arrangements among Hispanic and non-Hispanic females are more similar when we control for these three sets of factors, and that cultural desirability factors are particularly important. The likelihood that elderly Hispanic females will reside in an institution is actually decreased, however, when we control for these factors; this finding suggests a strong reluctance among Hispanics to use formal long-term care facilities.

Infant mortality: A multi-level analysis of individual and community risk factors

This paper reports the results of an analysis of infant mortality based on a conceptual model that combines micro-level and macro-level variables taken from demographic, sociological and epidemiological research traditions. Using generalized hierarchical linear modeling techniques, we analyze 1988 and 1989 linked birth and death records for Upstate New York matched with county-level data from government and private sources. Net of health and sociodemographic risk factors. our results show that the number of per capita primary care physicians and local government expenditures on health care services and hospitals are positively linked to an increase in the probability of infant death and that our indicator of hospital facilities is negatively related to risk of death. We also find that some negative health behaviors and health resources of mothers are mediated by the local health care environment. Our results demonstrate the utility of combining perspectives from several disciplines when evaluating infant death, especially the impact of policy-related issues concerning health care service in

Formal and Informal Volunteer Activity and Spousal Caregiving Among Older Adults

On the basis of data from the 1998 and 2000 waves of the Health and Retirement Study, this study tested two alternative hypotheses, role overload and role extension, about the relationship between volunteering and spousal caregiving among older married persons. Spousal caregiving was not significantly associated with the likelihood of formal or informal volunteering for men; however, female caregivers were found to be less likely than noncaregivers to have engaged in formal or informal volunteering to a certain extent, thus lending partial support to the role overload hypothesis. Functional health status and other human and cultural capital resources were significant predictors of both formal and informal volunteering for both men and women. Future studies need to examine in more depth the effect of spousal caregiving on volunteering, taking caregiving burden and stress into consideration, to more fully understand these two types of productive activity in later life.

Productive aging and civic participation

Abstract We argue that civic participation is one form of productive aging. We explore how age is related to different types and levels of civic participation among adults in Boston, MA. To accomplish our analysis, we employ recently released survey data from the Boston Area Study (BAS). Our results indicate that voting is the most common form of civic expression among Bostonians, followed by attending local government meetings. Volunteering for political organizations and candidates is the least common form of activity. Educational status is a strong predictor of most forms of civic-oriented activity and it is consistently related to activity for those persons 60 years old and older. Further, we evaluate a model of civic participation that shows a curvilinear relationship between age and various activities; this pattern holds after controlling for a number of other covariates. We discuss the contributions and limitations of our research and indicate additional steps that should be taken in future research to address some unresolved issues.

Changes in geographic proximity between parents and their adult children

This study employs a weighted sample of 2173 respondents aged 60 years and older who had at least one surviving adult child and valid distance measurements from both panels of the US National Survey of Families and Households. The aim is to examine the joint effects of each generations structural characteristics on the likelihood of distance moves. Distance moves include changes due to convergence (reduced distance to the closest child) and divergence (increased distance from the closest child) or no change. Proximity accounts for potential parent moves child moves or both moves. The degree of change beyond 36 miles is not a consideration. The analysis follows and expands the models of Silverstein on general life cycle migration. The model is expanded to take into consideration the characteristics of adult children (onset of widowhood and changes in functional physical limitations). It is assumed that the closest adult child is the same at first and second observation. Berks two stage method is used in the multinomial logistic model construction. The results show that economic well being and marital status were related to changes in geographic proximity. About 12.2% lived closer and 15.2% lived farther away at the second observation. Respondents who lived within 10 miles were the least likely to change distances. Of those elderly who lived within 11-35 miles of their closest adult child 44.6% changed the distance 33% moved closer and 11.6% moved farther away. 24.8% of the elderly moved between the surveys. 36.4% of the elderly did not move and had at least one child move. The likelihood of a reduced distance to the closest child (convergence) increased with an increase in functional limitations and widowhood. The higher the level of education and income the greater the likelihood of either convergence or divergence. Longer housing tenure by the elderly was related to lower likelihood of convergence. Increases in disability and a shift to widowhood had a statistically significant impact on decisions to live with a child and to move closer to a child. Living with a child was related to higher educational level and having more children. Living in a nonmetropolitan area reduced the likelihood. Demographic characteristics of respondents and children were not strong predictors of a change in geographic proximity.

The Demography of Disability and the Effects of Immigrant History: Older Asians in the United States

Using data from the 2000 U.S. census, we compare the older Asian population with U.S.-born, non-Hispanic whites with respect to three indicators of disability. Insofar as any Asian “advantage” in health vis-à-vis whites exists among the population aged 65 and over, our evidence suggests that it occurs primarily among the U.S.-born segments of this population. We also investigate how differences in disability levels among Asian immigrant groups are influenced by country of birth and by the combined effects of duration of residence in the United States and life cycle stage at entry. These results highlight the diversity of the older Asian population with respect to the ways in which immigration and origin history are linked to disability outcomes. We conclude that in later life, immigrant status confers few disability advantages among the Asian population in the United States.

Volunteering and Hypertension Risk in Later Life

Objective: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment. Method: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons. Results: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension. Discussion: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.