Kristin J. August

Testing Hypotheses Distilled from Four Models of the Effects of Health-Related Social Control

This study distilled and tested hypotheses derived from four models of the effects of social control on affect and health behavior among 401 college students involved in heterosexual dating relationships. Each model received at least some support. Consistent with the dual effects model, social control strategies predicted both health behavior change and negative affect. In accord with the domain-specific model, positive social control was related to positive affect and negative social control was related to negative affect. In partial support of the mediational model, positive social control exerted both a direct and an indirect effect via positive affect on health behavior change and negative social control exerted both a direct and an indirect effect via negative affect on hiding unhealthy behavior. As predicted by the contextual model, quality of dating relationship moderated the influence of positive and negative social control on hiding unhealthy behavior.

Does volunteering moderate the relation between functional limitations and mortality

Previous studies have demonstrated that functional limitations increase, and organizational volunteering decreases, the risk of mortality in later life. However, scant attention has been paid to investigating the joint effect of functional limitations and organizational volunteering on mortality. Accordingly, we tested the hypothesis that volunteering moderates the relation between functional limitations and risk of mortality. This prospective study used baseline survey data from a representative sample of 916 non-institutionalized adults 65 years old and older who lived in the continental United States. Data on mortality were extracted six years later from the National Death Index. Survival analyses revealed that functional limitations were associated with an increased risk of dying only among participants who never or almost never volunteered, suggesting that volunteering buffers the association between functional limitations and mortality. We conclude that although it may be more difficult for older adults with functional limitations to volunteer, they may receive important benefits from doing so.

Are spouses of chronically ill partners burdened by exerting health-related social control?

Spouses often seek to influence the health behaviors of chronically ill partners, but little research has examined whether spouses find such involvement to be burdensome. The current study examined this question in a sample of 191 nondiabetic spouses whose partners had type 2 diabetes. Results revealed that spouses who attempted to exert more control over their partners’ dietary behavior experienced greater burden, particularly when their partners exhibited poor dietary adherence and reacted negatively to spouses’ involvement. The findings contribute to a sparse body of knowledge on how spouses are affected by efforts to influence their chronically ill partners’ disease management.

When does spousal social control provoke negative reactions in the context of chronic illness? The pivotal role of patients’ expectations

Spouses often monitor and seek to alter each other’s health behavior, but such social control attempts can provoke behavioral resistance and emotional distress. Expectations regarding spouses’ roles in their partners’ health may influence reactions to spousal social control, with resistance and hostility less likely to occur among people who believe spouses should be involved in their partners’ health. Evidence consistent with this idea emerged in a study of 191 patients with type 2 diabetes. Patients with greater expectations for spousal involvement (particularly females) generally reacted less negatively to spousal control. The findings help to clarify when people with a chronic illness are likely to resist and resent, rather than appreciate, spousal control.

Underdiagnosed and Undertreated Depression Among Racially/Ethnically Diverse Patients With Type 2 Diabetes

OBJECTIVE To examine racial/ethnic differences in the prevalence of depressive symptoms and in provider recognition of depression among Latino, Asian, and non-Hispanic white patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Patients (n = 1,209) with type 2 diabetes were recruited from five university-affiliated primary care clinics for an observational study. RESULTS Vietnamese American (133, 59.4%) and Mexican American (351, 50.2%) patients were more likely to report symptoms consistent with clinical depression (Center for Epidemiological Studies Depression [CES-D] scale score ≥22) than non-Hispanic whites (119, 41.6%; F [2, 1206] = 8.05, P < 0.001). Despite comparable diabetes care, Vietnamese and Mexican patients with high depressive symptoms were less likely to be diagnosed and treated than non-Hispanic whites (all P values < 0.001). Minority patients who reported low levels of trust in their provider were less likely to have been diagnosed or treated for depression (adjusted odds ratio 0.65, 95% CI 0.44–0.98, P < 0.05). CONCLUSIONS Innovative strategies are needed to improve recognition of depressive symptoms in minority patients.

Racial and Ethnic Disparities in Indicators of Physical Health Status: Do They Still Exist Throughout Late Life?

Physical health problems become more common as people age and are associated with a great deal of disability. Although racial and ethnic disparities have been reported in physical health, little is known about whether these disparities remain in the latest part of older adulthood. Accordingly, the current study sought to examine racial and ethnic differences in the physical health status of three age groups of older adults, using the 2005 and 2007 California Health Interview Survey. The sample for the current study included 40,631 individuals aged 55 and older: 33,488 non‐Hispanic whites, 1,858 blacks, 2,872 Asians and Pacific Islanders, and 2,412 Latinos. Respondents were compared with regard to three indicators of physical health: four chronic health conditions, difficulties with activities of daily living, and self‐rated health. Analyses were conducted with and without adjustment for sex, marital status, education, English‐language proficiency, nativity, and insurance status. Results revealed that, in general, racial and ethnic disparities existed for physical health in late adulthood, with differences less pronounced for Asians and Pacific Islanders and Latinos aged 75 and older after multivariable adjustment. Disparities between blacks and non‐Hispanic whites and disparities across all racial and ethnic minorities in self‐rated health still existed. These findings suggest that, to reduce racial and ethnic disparities, clinicians need to address specific sociodemographic and lifestyle factors related to racial and ethnic differences in health before these conditions are manifested in late adulthood.

Support and influence in the context of diabetes management: Do racial/ethnic differences exist?

This study examined the sources and frequency of, and dietary behavioral responses to, health-related social support and control in a racially/ethnically diverse sample of 1,361 adults with type 2 diabetes. Spouses were the most frequently reported sources of support/control for all racial/ethnic groups examined. Mexican Americans and Vietnamese Americans received more support/control compared to non-Hispanic whites. All types of social involvement were associated with good dietary behavior for Mexican Americans, whereas only support was associated with good dietary behavior for non-Hispanic whites. The findings underscore the importance of considering racial/ethnic differences in examining social network members’ involvement in chronic disease management.

Language Concordance and Patient - Physician Communication Regarding Mental Health Needs

Language‐related communication barriers between minority patients and their physicians may contribute to racial and ethnic disparities in mental health care. Accordingly, the current study sought to examine whether perceived mental health needs and discussion of these needs differed as a function of race or ethnicity and language concordance in older Latinos and Asian and Pacific Islanders (APIs). Using the 2007 California Health Interview Survey, the analytical sample included Latinos and APIs aged 55 and older (N = 2,960) who reported having seen a primary care provider within the past 2 years. Multivariable logistic regression was used to examine differences according to race or ethnicity and language concordance status (three groups: English‐language concordant, other‐language concordant, language discordant) in perceived mental health needs and discussion of those needs with a physician, adjusting for respondents’ sociodemographic characteristics and mental health status. There were no significant differences in respondents’ perceptions of their mental health needs across race or ethnicity or level of language concordance status (Ps > .41), although there were significant differences in whether respondents had discussed their mental health needs with their physicians according to participant race or ethnicity and language concordance status (adjusted odds ratio = 0.47, P = .04). Specifically, Spanish language‐concordant Latinos were just as likely to discuss their mental health needs with their physicians as English language‐concordant Latinos. In contrast, Asian language‐concordant APIs were less likely to discuss their mental health needs with their physicians than English language‐concordant APIs. There were no significant differences between language‐discordant and English language‐concordant older adults in predicting discussion of mental health concerns. These findings underscore the importance of overcoming language‐related and cultural barriers to improve patient‐provider discussions of older adults’ mental health needs.

Costs and beliefs: Understanding individual- and neighborhood-level correlates of medication nonadherence among Mexican Americans with type 2 diabetes.

OBJECTIVE High rates of medication nonadherence observed in disadvantaged populations are often attributed to socioeconomic factors. Little is known, however, about how a persons neighborhood environment may contribute to nonadherence beyond what can be explained by a lack of individual resources to pay for medications. This study considered the reasons patients reported for deviating from their medication regimens to understand how individual-level and neighborhood-level indicators of socioeconomic status (SES) may each influence adherence behavior. METHOD Cross-sectional data were collected between 2006 and 2011 from a sample of Mexican American patients with type 2 diabetes (N = 749) treated at university-affiliated clinics in Southern California. Measures included individual-level SES (years of education, health insurance type, and household income), neighborhood deprivation, and medication nonadherence (for reasons related to cost and reasons related to beliefs about medications). Neighborhood deprivation was assessed using the Neighborhood Socioeconomic Status Index (Dubowitz et al., 2011), a validated aggregate of census tract-level indicators linked to each participants home address. RESULTS RESULTS from multilevel logistic regression models revealed that individual-level SES was associated with nonadherence related to cost (annual household income <

Physical activity–related social control and social support in older adults: Cognitive and emotional pathways to physical activity

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