Maria T. Brown

Same-Sex Sexual Relationships in the National Social Life, Health and Aging Project: Making a Case for Data Collection

This study describes the previously unexplored subsample of respondents who reported at least 1 same-sex sexual relationship (SSSR) in the National Social Life, Health, and Aging Project (NSHAP). The NSHAP collected data from 3,005 adults (aged 57–85). Approximately 4% (n = 102) of respondents reported at least one SSSR. These sexual minority elders were younger, more educated, were more likely to be working, had fewer social supports, and better physical health. Results may indicate crisis competence in sexual minority elders. Collecting sexual orientation and gender identity data in larger, US-based probability samples would inform the development of appropriate community-based services and supports.

Early-Life Characteristics, Psychiatric History, and Cognition Trajectories in Later Life

PURPOSE OF THE STUDY Although considerable attention has been paid to the relationship between later-life depression and cognitive function, the relationship between a history of psychiatric problems and cognitive function is not very well documented. Few studies of relationships between childhood health, childhood disadvantage, and cognitive function in later life consider both childhood health and disadvantage, include measures for psychiatric history, or use nationally representative longitudinal data. DESIGN AND METHODS This study uses growth curve models to analyze the relationships between childhood health and disadvantage, psychiatric history, and cognitive function using 6 waves of the Health and Retirement Study, controlling for demographics, health behavior, and health status. RESULTS A history of psychiatric problems is associated with lower cognitive function and steeper declines in cognitive function with age. The influence of childhood health is mediated by later-life health status and behaviors. A combined history of childhood disadvantage and psychiatric problems more strongly affects cognitive function, but cognitive declines remain consistent with those associated with psychiatric history. These effects are partially mediated by later-life demographic, socioeconomic, or health characteristics. IMPLICATIONS These findings demonstrate that cumulative disadvantage and a history of psychiatric problems shape later-life cognition and cognitive decline. This evidence can enhance public understanding of the trajectories of cognitive decline experienced by groups living with disadvantage and can enable policy makers and human services providers to better design and implement preventative interventions and support services for affected populations.

Sexual and gender minority breast cancer patients choosing bilateral mastectomy without reconstruction: “I now have a body that fits me”

ABSTRACT Sexual and gender minority (SGM) breast cancer patients have begun embracing the choice to “go flat” or opt out of reconstruction after bilateral mastectomy, though little is known about this population. SGM breast cancer survivors were identified through purposive and referral sampling and invited to participate in a web-based survey containing both closed- and open-ended items. Of the sixty-eight SGM breast cancer survivors aged 18–75 years who completed the survey between May 2015 and January 2016, 25 percent reported “going flat” (flattoppers®). Bivariate analyses revealed that flattoppers® were significantly more likely to have been diagnosed in the past five years, to identify as genderqueer, to have disclosed their sexual orientation or gender identity (SOGI) to providers, and to report participating in lesbian, gay, bisexual, or transgender cancer support groups, compared to other participants. More flattoppers® believed that SOGI mattered in terms of getting the support they needed regarding their cancer; this difference was not statistically significant. Thematic analysis of qualitative comments from flattoppers® revealed themes related to reasons for making this treatment choice, interactions with health-care providers around treatment choice, and physical and emotional outcomes of treatment choice. Providers would benefit from training about SOGI as they relate to treatment choices.

Parent–Adult Child Religious Discordance: Consequences for Intergenerational Solidarity Across Several Decades:

This article focused on the relationship between parent–child religious discordance (affiliation, intensity, and attendance) in early adulthood and children’s perceived affectual and associational solidarity with their parents across 20 years. The data derived from eight waves of the Longitudinal Study of Generations between 1971 and 2005. We selected 635 young adult children whose mothers and/or fathers also reported their religious orientations in 1971 and then constructed mother–child dyads (n = 584) and father–child dyads (n = 475). Results showed that religious affiliation discordance between parents and children negatively and consistently lowered children’s affectual and associational solidarity with parents over several decades regardless of parents’ gender. However, intergenerational discordance in religious intensity and religious attendance showed no such association. These findings indicate that discontinuity in denominational identification is more disruptive to intergenerational relations than discontinuity in religious strength and practice.

Veteran Status and Men’s Later-Life Cognitive Trajectories Evidence from the Health and Retirement Study

Objective: The aim of this study is to determine the extent to which men’s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men’s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations.

Estimating the Prevalence of Serious Mental Illness and Dementia Diagnoses Among Medicare Beneficiaries in the Health and Retirement Study

Objective: To estimate the prevalence of serious mental illness and dementia among Medicare beneficiaries in the Health and Retirement Study (HRS). Methods: This study utilizes HRS-linked Medicare claims data sets and inverse probability weighting to estimate overall and age-specific cumulative prevalence rates of dementia and serious mental illnesses among 18,740 Medicare beneficiaries. Two-way tabulations determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, and binary logistic regressions determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, controlling for covariates. Results: Weighted prevalence estimates for dementia, schizophrenia (SZP), bipolar disorder (BPD), and major depressive disorder (MDD) are similar to previous studies. Odds of dementia diagnosis are significantly greater for beneficiaries diagnosed with SZP, BPD, or MDD. Conclusions: Co-occurring mental disabilities require further investigation, as in the near future increasing numbers of mentally ill older adults will need appropriate and affordable community-based services and supports.

Evaluating the effectiveness of faith-based breast health education

Objective: In an effort to evaluate the effectiveness of faith-based health promotion programmes in educating African American women about breast cancer knowledge and risks, the local affiliate of a national breast cancer research foundation funded the Genesis Health Project (GHP) Network, a community-designed, culturally competent intervention, to develop, implement and evaluate the Breast Cancer Awareness and Education Program. This article reports on the faith-based education model used and uses evaluation data to determine whether the intervention improved awareness of breast cancer risk, methods for reducing risk, the importance of early detection and the availability of low-cost or free mammograms. Design: Pastoral health messaging and culturally appropriate strategies were used to heighten awareness of breast cancer risks and prevention, promote mammography and early detection, increase awareness of free/low-cost mammography and encourage the adoption of healthier behaviours. Setting: African American churches and collaborators targeting African American women in a mid-sized city in the northeastern USA. Method: Summative evaluations used paper and pencil pre- and post-event surveys, with measures for objectives targeted by the programme to evaluate the impact of activities. Results: Overall, participants in the Breast Cancer Awareness and Education Program showed improvements in general knowledge about breast cancer, higher breast cancer mortality among African American women, warning signs, risks and ways to mitigate risk, and the availability of low-cost or free mammograms. Conclusion: Findings confirm that faith-based health promotion programmes can be effective in helping to educate inner-city African American women about breast cancer and associated risk factors.

Addressing Behavioral Cancer Risks from a LGBT Health Equity Perspective

Accounting for individual, community, and societal factors, as well as historical context and life-course events, we utilize a Health Equity model to consider behavioral risks and identify social determinants that may influence cancer risks in LGBT populations. Based on data from available research, we provide estimates of the prevalence of behavioral risks in LGBT communities, including excessive drinking and substance abuse, obesity, poor nutrition and diet, and physical inactivity. Both upstream and downstream factors that may elevate such behavioral risks for cancer among LGBT populations, including those unique to particular subgroups, are discussed. Examples of innovative programs and interventions designed for LGBT communities to target cancer-related behavioral risks are briefly described. We conclude with research, practice, and policy recommendations that are needed to promote health equity and reduce the disparate cancer burden in LGBT communities.