Maureen Wilson-Genderson

Successful Aging: Early Influences and Contemporary Characteristics

PURPOSE positing that successful aging has independent, yet related, dimensions that are both objective and subjective, we examine how early influences and contemporary characteristics define 4 groups of people. DESIGN AND METHODS data were gathered from 5,688 persons aged 50-74 years living in New Jersey who participated in telephone interviews. Latent profile analysis defined people who age successfully according to both objective and subjective criteria, neither criteria, and one, but not the other, criteria. Multinomial logistic regression was used to examine the extent to which early influences and contemporary characteristics predict group membership. RESULTS although characteristics observable early in life predict group membership, their influence is modified by current health behaviors and social support. The roles of education and incarceration feature prominently. Marital, work, and volunteer statuses, as well as moderate alcohol consumption, distinguish those aging successfully according to both criteria from the other 3 groups. IMPLICATIONS results help to define successful aging as a multidimensional construct having both objective and subjective dimensions, provide greater clarity regarding its correlates, and increase understanding of its modifiable aspects.

Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment

 Objective: This study investigated depressive symptomatology in lung cancer patients and their identified caregiver.

Effects of neighborhood violence and perceptions of neighborhood safety on depressive symptoms of older adults.

Violent crime within a neighborhood as well as perceptions of neighborhood safety may impact the depressive symptoms experienced by community-dwelling older people. Most studies examining the influences of neighborhood characteristics on mental health have included either objective indicators or subjective perceptions and most operationalize neighborhood as a function of socioeconomic status. This study examines the effects that objectively assessed neighborhood violent crime and subjective perceptions of neighborhood safety in tandem have on depressive symptoms. The sample identified using random-digit-dialing procedures included 5688 persons aged 50-74 living in New Jersey (USA). Using multilevel structural equation analyses, we tested the hypothesis that higher levels of neighborhood violent crime and poorer perceptions of neighborhood safety are associated with higher levels of depressive symptoms, controlling for age, sex, and household income. Results supported the hypotheses. We conclude that interventions at the neighborhood level that reduce violent crime may be needed to compliment efforts at the individual level in order to reduce the depressive symptoms experienced by older people.

Education level, not health literacy, associated with information needs for patients with cancer.

OBJECTIVE Cancer patients receiving adjuvant therapy encounter increasingly complex situations and decisions with each new procedure and therapy. To make informed decisions about care, they need to be able to access, process, and understand information. Individuals with limited health literacy may not be able to obtain or understand important information about their cancer and treatment. The rate of low health literacy has been shown to be higher among African Americans than among non-Hispanic Whites. This study examined the associations between race, health literacy, and self-reported needs for information about disease, diagnostic tests, treatments, physical care, and psychosocial resources. METHODS Measures assessing information needs were administered to 138 newly diagnosed cancer patients. Demographics were assessed by survey and health literacy was assessed with two commonly used measures: the Rapid Estimate Adult Literacy in Medicine (REALM) and the Short Test of Health Literacy in Adults (STOFHLA). RESULTS Study findings indicate that educational attainment, rather than health literacy, is a significant predictor of information needs. CONCLUSION Overcoming barriers to information needs may be less dependent on literacy considerations and more dependent on issues that divide across levels of educational attainment. PRACTICE IMPLICATIONS Oncologists and hospital staff should be attentive to the fact that many patients require additional assistance to meet their information needs.

Health Disparities Among Children With Cleft

Oral health-related quality of life (OHRQoL) is a multidimensional construct that measures well-being associated with the teeth, mouth, and face. This cross-sectional study examined OHRQoL, demographic data, and clinical indicators in 839 treatment-seeking youths with cleft from 6 geographically diverse cleft treatment centers. Individuals without health insurance and representing ethnic minorities had lower OHRQoL scores on the Child Oral Health Impact Profile and a higher rate of surgical recommendations. These findings imply a risk factor for reduced OHRQoL and unmet needs among vulnerable youths with clefts.

The Texture of Neighborhoods and Disability Among Older Adults

OBJECTIVES To present and test an ecological multidimensional model of neighborhood characteristics and examine its relationship to older disability among older adults. METHOD Indicators of social vulnerability, wealth, violence, storefronts, residential stability, and the presence of physicians, supermarkets, and fast-food establishments for 1,644 of New Jerseys census tracts were derived from sources that include the U.S. Census 2000, Uniform Crime Report for New Jersey, New Jersey Department of Agriculture, Division of Marketing and Development, New Jersey Department of Law and Public Safety Division of Alcohol Beverage Control, and Health Resources and Services Administration Geospatial Data Warehouse. Confirmatory factor analyses were used to develop and test a measurement model of neighborhood texture. Structural equation modeling examined the relationships between neighborhood characteristics and disability of persons aged 65-69 years. RESULTS Analyses revealed that distinct dimensions of neighborhoods could be modeled with administrative data and that neighborhood contextual (supermarkets, physicians, storefronts, violence) and compositional (social vulnerability, wealth, residential stability) characteristics were related to the prevalence of disability. DISCUSSION The use of multiple indicators of neighborhood with good psychometric qualities is critical for advancing knowledge about the mechanisms by which neighborhood characteristics are associated with the health of older people.

Barriers to therapeutic clinical trials enrollment: Differences between African-American and White cancer patients identified at the time of eligibility assessment

Background Clinical trials (CTs) are the mechanism by which research is translated into standards of care. Low recruitment among underserved and minority populations may result in inequity in access to the latest technology and treatments, compromise the generalizability, and lead to failure in identification of important positive or negative treatment effects among under-represented populations. Methods Data were collected over a 39-month period on patient eligibility for available therapeutic cancer CTs. Reasons for ineligibility and refusal were collected. The data were captured using an automated software tool for tracking eligibility pre-enrollment. We examined characteristics associated with being evaluated for a trial, and reasons for ineligibility and refusal, overall and by patient race. Results African-Americans (AAs) were more likely than Whites to be ineligible (odds ratio, (OR) = 1.26, 95% confidence interval (CI) = 1.0–1.58) and if eligible, to refuse participation (OR = 1.79, 95% CI = 1.27–2.52), even after adjusting for insurance, age, gender, study phase, and cancer type. White patients were more likely to be ineligible due to study-specific or cancer characteristics. AAs were more likely to be ineligible due to mental status or perceived noncompliance. Whites were more likely to refuse due to extra burden, due to concerns with randomization and toxicity, or because they express a positive treatment preference. AAs were more likely to refuse because they were not interested in CTs, because of family pressures, or they felt overwhelmed (NS)). Discussion This study is the first to directly compare ineligibility and refusal rates and reasons captured prospectively in AA and White cancer patients. The data are consistent with earlier studies that indicated that AA patients more often are deemed ineligible and, when eligible, more often refuse participation. However, differences in reasons for ineligibility and refusal by race have implications for a cancer center to participate in CTs appropriate for the population of patients served. On a broader scale, consideration should be given to modifying eligibility criteria and other design aspects to permit broader participation of minority and other underserved groups.

A Longitudinal Examination of the Effects of Early Influences and Midlife Characteristics on Successful Aging

OBJECTIVES Previous research revealed that successful aging includes both objective and subjective dimensions. This longitudinal analysis examines how early life influences and midlife characteristics predict stability and change in successful aging over a 4-year period. METHOD Data from 3,379 people living in New Jersey who completed baseline telephone interviews between 2006 and 2008 and follow-up mail surveys in 2011 were analyzed. Latent profile analysis identified people who aged successfully according to both objective and subjective criteria, neither criteria, and one, but not the other criteria. Multinomial logistic regressions analyses focused on the 2,614 people who were successful according to both objective and subjective criteria at baseline. RESULTS At follow-up, 18.1% people successful at baseline had transitioned out of that status. Characteristics identifiable early in life (gender, race, education, never marrying, incarceration) as well as midlife status (currently married, working), health behaviors (smoking, drinking, body mass index, exercise), and social support distinguished people who continued to age successfully 4 years later from those who did not. DISCUSSION Findings suggest that successful aging is a fluid construct and that although some characteristics identifiable early in life predict successful aging, others are dampened by midlife statuses.

Examination of a Theoretical Model for Oral Health–Related Quality of Life Among Youths With Cleft

OBJECTIVES We evaluated relationships among physical and psychological indicators and oral health-related quality of life (OHRQOL) in youths with cleft. METHODS We recruited youths aged 7 to 18 years with cleft palate (n = 282) or cleft lip and palate (n = 918) and their caregivers into a 5-year observational investigation at 6 US treatment centers from 2009 to 2011. At baseline, youths completed surveys to assess psychological status. After clinical evaluation, 433 youths received a recommendation for surgery. We developed structural models from the baseline data incorporating age, gender, race, and cleft diagnosis to examine direct relationships between depressive symptoms and, in separate models, self-concept and sense of mastery and OHRQOL. Subsequent models examined the possible mediating effect of surgical recommendation. RESULTS Depressive symptoms were negatively and self-concept and self-efficacy were positively associated with OHRQOL. Surgical recommendation appeared to mediate the effect of psychological well-being, but not depression, on OHRQOL, even after adjustment for cleft diagnosis. In some models, individual-level characteristics were significant. CONCLUSIONS Path analyses support the theoretical model and underscore the importance of examining positive psychosocial characteristics such as resiliency and self-concept in this patient population.

Neighborhood Food Environment and Obesity in Community-Dwelling Older Adults: Individual and Neighborhood Effects

OBJECTIVES We tested hypotheses about the relationship between neighborhood-level food sources and obesity, controlling for individual-level characteristics. METHODS Data (collected November 2006-April 2008) derived from a random-digit-dial sample of 5688 community-dwelling adults aged 50 to 74 years residing in 1644 census tracts in New Jersey. Using multilevel structural equation models, we created latent constructs representing density of fast-food establishments and storefronts (convenience stores, bars and pubs, grocery stores) and an observed indicator for supermarkets at the neighborhood level, simultaneously modeling obesity and demographic characteristics (age, gender, race, education, household income) at the individual level. RESULTS When we controlled for individual-level age, gender, race, education, and household income, densities of fast-food establishments and storefronts were positively associated with obesity. Supermarkets were not associated with obesity. CONCLUSIONS Because people living in neighborhoods with a higher density of fast food and storefronts are more likely to be obese, these neighborhoods may be optimal sites for interventions.