Manacy Pai

Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review

Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States. (Cancer Epidemiol Biomarkers Prev 2008;17(11):2913–23)

Volunteering and Trajectories of Depression

Objective: The purpose of this study was twofold: (1) to examine the association between volunteering and trajectories of depression; and (2) to evaluate whether this relationship varies by age. Method: Data come from three waves of the Americans’ Changing Lives (ACL) study. ACL is a nationally representative sample of adults 25 years of age or older who lived in the United States. Results: Latent growth model analysis indicates that although volunteering is associated with lower levels of baseline depression, it does not predict trajectories of depression. Nevertheless, further analyses reveal an age variation in the relationship between volunteering and trajectories of depression. Specifically, we find that volunteering affects the decline of depression for individuals above age 65; yet there is no effect of volunteering on trajectories of depression for younger and middle-aged adults. Discussion: Overall findings highlight the importance of assessing the long-term health impact of volunteering and doing so under diverse social structural contexts.

Do Personality Traits Moderate the Effect of Late-Life Spousal Loss on Psychological Distress?

We use data from the Changing Lives of Older Couples (CLOC) study to investigate the extent to which: (1) five personality traits (agreeableness, conscientiousness, emotional stability/neuroticism, extraversion, and openness) moderate the effect of late-life spousal loss on depressive symptoms; (2) these patterns vary based on the expectedness of the death; and (3) the patterns documented in (1) and (2) are explained by secondary stressors and social support. Widowed persons report significantly more depressive symptoms than married persons, yet the deleterious effects of loss are significantly smaller for highly extraverted and conscientious individuals. The protective effects of personality traits, however, vary based on the expectedness of the death. Extraversion is protective against depression only for persons who had forewarning of the death. Extraverts may be particularly good at marshalling social support during prolonged periods of spousal illness. We discuss the ways that extraversion and conscientiousness may buffer against bereavement-related stressors.

“It's your badge of inclusion”: The Red Hat Society as a gendered subculture of aging

Although studies document the health-enhancing effects of social engagement, they reveal little about the underlying mechanisms operating within specific organizational contexts. Limited attention is given to the role of inequality--particularly age and gender--in shaping either the organizations to which we belong or their consequences for our well-being. We address this issue by examining the Red Hat Society, a social organization for middle-aged and older women. Interviews with members (n=52) illustrate how age and gender inequality interact to shape the organization, which can be viewed as a gendered subculture of aging. Drawing on this framework, we discuss four processes through which participation generates benefits for older women involved in age- and gender-segregated organizations: enhancing social networks, countering invisibility, creating positive frames for aging experiences, and promoting youthful identities.

Reciprocity Between Depressive Symptoms and Physical Limitations Pre- and Postretirement Exploring Racial Differences

Objectives: This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. Method: Data are from the 1994 to 2008 waves of the Health and Retirement Study. Results: Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. Discussion: The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race.

Sketches in Cyberspace: Using Student Drawings of Elders in an Online Social Gerontology Course

ABSTRACT Much of the literature on teaching gerontology derives from experiences in face-to-face settings. There is limited discussion of either the applicability of teaching techniques drawn from the traditional setting to the online environment or the development of novel strategies to engage distance students of aging. We developed and assessed an exercise designed to stimulate an online, asynchronous discussion of ageism in a Web-based social gerontology course. The exercise required students to analyze patterns found in sketches of elders drawn by themselves and their peers. The activity, which was favorably evaluated by our students, provided a springboard for discussion of the origins and consequences of ageism, as well as issues at the intersection of gender and age inequality.

Long-Term Payoffs of Work? Women's Past Involvement in Paid Work and Mental Health in Widowhood

This study examines a domain of life—involvement in paid work—that has not been explored in prior research addressing the mental health consequences of widowhood. We argue that experiences in the paid labor force increase womens economic, social and psychological resources, which compound over the life course and ease their adjustment to widowhood. Using a sample of 207 widows interviewed in the Miami-Dade County, Florida area in 2001—2002, findings from ordinary least squares (OLS) regression models support the hypothesis that widows with work histories report fewer depressive symptoms than their peers without employment experience. Further analyses reveal that social and psychological resources mediate this association suggesting that employment enhances social support and self-perceptions, which reduce the negative health effects of widowhood. Our study illustrates the importance of incorporating work histories into examinations of widowhood, particularly as cohorts of women with considerable lifetime investments in paid work enter their later years.

Subjective Memory Problems and Availability of Emotional Support

This study examines (1) whether subjective memory problems (SMP) influence perceived emotional support from and frequency of contact with family and friends; and, (2) the extent to which this relationship is moderated by gender, education, and functional limitations. We use the 2014 wave of the Health and Retirement Study, a nationally representative panel survey of adults aged 51 and over in the United States. While SMP does not affect perceived emotional support for younger group (YG; aged 51–64), in older group (OG; aged 65+), SMP is associated with reduced perceived support from friends. Also, SMP is predictive of fewer writing-based contact with children and friends among OG but not among YG. Lastly, we find that the effect of SMP on support from children is contingent upon activity of daily living (YG) and gender (OG), while the effect of SMP on writing-based contact with both children and friends is contingent upon education (YG only).

Neighborhood Physical Disorder and Psychological Distress: Does the Risk Increase With Age?

Although research documents a link between neighborhood physical disorder and psychological distress, we know little about the extent to which this association varies by age. Utilizing the person–environment fit model and drawing on data from the fourth wave of the Americans’ Changing Lives Survey, we examine the extent to which age influences the association between perceptions of neighborhood physical disorder and psychological distress, as measured by depressive symptoms. We employ both continuous and categorical measures of age to test for a potential moderating effect. Overall findings based on linear regression analyses reveal that the mental distress resulting from the perception of physically deteriorating neighborhood declines with age. Stated otherwise, we find that the psychological distress associated with the perception of neighborhood physical disorder is far less pronounced for the young-old (60 years and above) and late-old (70 years and above) adults as compared with their young middle-aged (40–49 years) and late middle-aged (50–59 years) counterparts.

Impact of Mid-Life Symptoms of Alcoholism on the Health and Wellbeing of Aging Parents of Adults with Disabilities.

ABSTRACT The study examined the effect of adult children’s disability on parents’ physical health in later life and the extent to which parents’ symptoms of alcoholism in mid-life moderates the link between children’s disability and later life parental health. Analyses are based on data from the Wisconsin Longitudinal Study. The analytic sample included parents of children with developmental disabilities (n = 145) or mental health problems (n = 200) and 2,432 parents of unaffected children. The results showed that the negative health consequences in later life of having a child with a developmental disability were greater for those who showed more symptoms of alcoholism in mid-life. However, symptoms of alcoholism in mid-life did not significantly moderate the impact of an adult child’s mental health problems on parents’ later life physical health. The findings suggest a potential area where gerontological social workers could intervene, given the negative impact of symptoms of alcoholism on the health of aging parents of children with a disability who may be significantly more susceptible to the negative health impacts of alcohol compared to their younger counterparts.